Prognostic factors and analysis of mortality due to brain haemorrhages associated with vitamin K antagonist oral anticoagulants. Results from the TAC registry
Por:
Zapata-Wainberg, G, Quintas, S, Rico, AX, Fernandez, LB, Vallejo, JM, Cullere, JG, Guerrero, MDF, Egido, J, Sanchez, JCG, Domeno, AM, Purroy, F, Pastor, BV, Yanez, MR, Vivancos, J
Publicada:
1 sep 2018
Resumen:
Introduction: Intracranial haemorrhages (ICH) represent a severe and frequently lethal complication in patients treated with vitamin K antagonists (VKA). The purpose of our study is to describe the factors and clinical features associated with mortality in these patients.
Methods: We conducted an observational, retrospective, multi-centre study based on prospective stroke registries in Spain. We included all patients admitted to neurology departments during a one-year period who met the following inclusion criteria: being 18 or older, having a diagnosis of ICH, and receiving VKA. Clinical and radiological parameters and 3-month outcomes were analysed.
Results: A total of 235 patients from 21 hospitals were included. Mortality rate at 90 days was 42.6%. Bivariate analysis showed a significant association between death and the following factors: median NIHSS score at admission (5 [IQR = 9] vs 17 [IQR = 14] points, P < .01) and presence of an extensive hemispheric haemorrhage (4.9% vs 35%, P < .01; chi(2)). Extensive hemispheric haemorrhages, in addition to being the most lethal type, were associated with a shorter time to death (mean of 16.5 days; 95% CI: 7.1-26). A logistic regression model showed that only baseline NIHSS scores independently predicted death (odds ratio =1.13 [95% CI: 1.08-1.17] for each point in the scale).
Conclusion: ICH in patients treated with VKA is associated with high mortality rates; mortality in these patients is mainly and independently associated with the clinical situation at stroke onset. (C) 2016 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U. All rights reserved
Filiaciones:
Zapata-Wainberg, G:
Hosp Univ La Princesa, Serv Neurol, Inst Invest Sanitaria La Princesa, Madrid, Spain
Quintas, S:
Hosp Univ La Princesa, Serv Neurol, Inst Invest Sanitaria La Princesa, Madrid, Spain
Rico, AX:
Hosp Univ La Princesa, Serv Neurol, Inst Invest Sanitaria La Princesa, Madrid, Spain
Fernandez, LB:
Hosp Univ Cent Asturias, Serv Neurol, Oviedo, Spain
Vallejo, JM:
Univ Alcala De Henares, IRYCIS, Hosp Univ Ramon y Cajal, Serv Neurol, Madrid, Spain
Cullere, JG:
Complejo Hosp Navarra, Serv Neurol, Pamplona, Navarra, Spain
Guerrero, MDF:
Hosp Univ Basurto Bilbao, Serv Neurol, Vizcaya, Spain
Egido, J:
Hosp Univ Clin San Carlos, Serv Neurol, Madrid, Spain
Sanchez, JCG:
Hosp Univ Salamanca, Serv Neurol, Salamanca, Spain
Domeno, AM:
Hosp Santa Creu & Sant Pau, Serv Neurol, Barcelona, Spain
Purroy, F:
Hosp Arnau Vilanova, Serv Neurol, Lleida, Spain
Pastor, BV:
Hosp Univ Son Espases, Serv Neurol, Mallorca, Islas Baleares, Spain
Yanez, MR:
Hosp Clin Univ Santiago de Compostela, Serv Neurol, Santiago De Compostela, Spain
Vivancos, J:
Hosp Univ La Princesa, Serv Neurol, Inst Invest Sanitaria La Princesa, Madrid, Spain
Gold
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