Coagulation Testing in Intracerebral Hemorrhage Related to Non-vitamin K Antagonist Oral Anticoagulants
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ORIGINAL ARTICLE
Coagulation Testing in Intracerebral Hemorrhage Related to Non-vitamin K Antagonist Oral Anticoagulants Jan C. Purrucker1 • Timolaos Rizos1 • Kirsten Haas2 • Marcel Wolf3 • Shujah Khan1 • Peter U. Heuschmann2,4,6 • Roland Veltkamp1,5 • on behalf of the RASUNOA investigators
Ó Springer Science+Business Media New York 2017
Abstract Background Intracerebral hemorrhage (ICH) is a lifethreatening complication of non-vitamin K antagonist oral anticoagulants (NOAC). Little is known about the effect of intensity of anticoagulation on NOAC-ICH. We describe the current use of coagulation testing in the emergency setting and explore associations with baseline size and expansion of hematoma as determined in a previous study. Methods Data from the prospective multicenter RASUNOA registry were analyzed. Patients with NOAC-ICH were enrolled between February 2012 and December 2014. Frequency of local test performance of specific (anti-factor Xa tests, diluted thrombin time) and non-specific tests (international normalized ratio (INR), activated partial thromboplastin time (aPTT), thrombin time) was analyzed.
Electronic supplementary material The online version of this article (doi:10.1007/s12028-017-0403-x) contains supplementary material, which is available to authorized users.
The association of anticoagulation intensity at admission with hematoma volume and hematoma expansion was explored. Results In 61 NOAC-ICH patients enrolled at 21 centers, drug-specific coagulation testing was performed in 16 cases (26%), and only 29% of centers appeared to use drugspecific tests in NOAC-ICH at all. In some cases, INR and aPTT values were normal despite drug concentrations in the peak range. In patients with available drug-specific concentrations, 50% had drug levels in the peak range at admission. Higher intensity of anticoagulation was not associated with higher hematoma volume at admission or with subsequent hematoma expansion. Conclusion Drug-specific tests are only infrequently used in NOAC-ICH. Normal results in non-specific coagulation do not reliably rule out peak range concentrations. Anticoagulation intensity at admission does not predict baseline hematoma volume or subsequent hematoma expansion. Keywords Stroke Intracerebral hemorrhage Anticoagulation Laboratory testing Oral anticoagulants
& Roland Veltkamp [email protected] 1
Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
2
Institute of Clinical Epidemiology and Biometry, University Wu¨rzburg, Wu¨rzburg, Germany
3
Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
4
Comprehensive Heart Failure Center, University Hospital Wu¨rzburg, Wu¨rzburg, Germany
5
Department of Stroke Medicine, Imperial College London, Charing Cross Campus, Fulham Palace Road, London W6 8RF, UK
6
Clinical Trial Center, University Hospital Wu¨rzburg, Wu¨rzburg, Germany
Introduction Intracerebral hemorrhage (ICH) is the most feared complication of long-term anticoagulation. Recent findings suggest
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