Sex-Differences in Oral Anticoagulant-Related Intracerebral Hemorrhage
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Sex-Differences in Oral Anticoagulant-Related Intracerebral Hemorrhage. / Grundtvig, Josefine; Ovesen, Christian; Steiner, Thorsten; Carcel, Cheryl; Gaist, David; Christensen, Louisa; Marstrand, Jacob; Meden, Per; Rosenbaum, Sverre; Iversen, Helle K.; Kruuse, Christina; Christensen, Thomas; Ægidius, Karen; Havsteen, Inger; Christensen, Hanne.
In: Frontiers in Neurology, Vol. 13, 832903, 2022.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Sex-Differences in Oral Anticoagulant-Related Intracerebral Hemorrhage
AU - Grundtvig, Josefine
AU - Ovesen, Christian
AU - Steiner, Thorsten
AU - Carcel, Cheryl
AU - Gaist, David
AU - Christensen, Louisa
AU - Marstrand, Jacob
AU - Meden, Per
AU - Rosenbaum, Sverre
AU - Iversen, Helle K.
AU - Kruuse, Christina
AU - Christensen, Thomas
AU - Ægidius, Karen
AU - Havsteen, Inger
AU - Christensen, Hanne
N1 - Publisher Copyright: Copyright © 2022 Grundtvig, Ovesen, Steiner, Carcel, Gaist, Christensen, Marstrand, Meden, Rosenbaum, Iversen, Kruuse, Christensen, Ægidius, Havsteen and Christensen.
PY - 2022
Y1 - 2022
N2 - Introduction and Aim: Data remain limited on sex-differences in patients with oral anticoagulant (OAC)-related intracerebral hemorrhage (ICH). We aim to explore similarities and differences in risk factors, acute presentation, treatments, and outcome in men and women admitted with OAC-related ICH. Method: This study was a retrospective observational study based on 401 consecutive patients with OAC-related ICH admitted within 24 h of symptom onset. The study was registered on osf.io. We performed logarithmic regression and cox-regression adjusting for age, hematoma volume, Charlson Comorbidity Index (CCI), and pre-stroke modified Ranking Scale (mRS). Gender and age were excluded from CHA2DS2-VASc and CCI was not adjusted for age. Results: A total of 226 men and 175 women were identified. More men were pre-treated with vitamin K-antagonists (73.5% men vs. 60.6% women) and more women with non-vitamin K-antagonist oral anticoagulants (26.5% men vs. 39.4% women), p = 0.009. Women were older (mean age 81.9 vs. 76.9 years, p < 0.001). CHA2DS2-VASc and CCI were similar in men and women. Hematoma volumes (22.1 ml in men and 19.1 ml in women) and National Institute of Health Stroke Scale (NIHSS) scores (13 vs. 13) were not statistically different, while median Glasgow Coma Scale (GCS) was lower in women, (14 [8;15] vs. 14 [10;15] p = 0.003). Women's probability of receiving reversal agents was significantly lower (adjusted odds ratio [aOR] = 0.52, p = 0.007) but not for surgical clot removal (aOR = 0.56, p = 0.25). Women had higher odds of receiving do-not-resuscitate (DNR) orders within a week (aOR = 1.67, p = 0.04). There were no sex-differences in neurological deterioration (aOR = 1.48, p = 0.10), ability to walk at 3 months (aOR = 0.69, p = 0.21) or 1-year mortality (adjusted hazard ratio = 1.18, p = 0.27). Conclusion: Significant sex-differences were observed in age, risk factors, access to treatment, and DNRs while no significant differences were observed in comorbidity burden, stroke severity, or hematoma volume. Outcomes, such as adjusted mortality, ability to walk, and neurological deterioration, were comparable. This study supports the presence of sex-differences in risk factors and care but not in presentation and outcomes.
AB - Introduction and Aim: Data remain limited on sex-differences in patients with oral anticoagulant (OAC)-related intracerebral hemorrhage (ICH). We aim to explore similarities and differences in risk factors, acute presentation, treatments, and outcome in men and women admitted with OAC-related ICH. Method: This study was a retrospective observational study based on 401 consecutive patients with OAC-related ICH admitted within 24 h of symptom onset. The study was registered on osf.io. We performed logarithmic regression and cox-regression adjusting for age, hematoma volume, Charlson Comorbidity Index (CCI), and pre-stroke modified Ranking Scale (mRS). Gender and age were excluded from CHA2DS2-VASc and CCI was not adjusted for age. Results: A total of 226 men and 175 women were identified. More men were pre-treated with vitamin K-antagonists (73.5% men vs. 60.6% women) and more women with non-vitamin K-antagonist oral anticoagulants (26.5% men vs. 39.4% women), p = 0.009. Women were older (mean age 81.9 vs. 76.9 years, p < 0.001). CHA2DS2-VASc and CCI were similar in men and women. Hematoma volumes (22.1 ml in men and 19.1 ml in women) and National Institute of Health Stroke Scale (NIHSS) scores (13 vs. 13) were not statistically different, while median Glasgow Coma Scale (GCS) was lower in women, (14 [8;15] vs. 14 [10;15] p = 0.003). Women's probability of receiving reversal agents was significantly lower (adjusted odds ratio [aOR] = 0.52, p = 0.007) but not for surgical clot removal (aOR = 0.56, p = 0.25). Women had higher odds of receiving do-not-resuscitate (DNR) orders within a week (aOR = 1.67, p = 0.04). There were no sex-differences in neurological deterioration (aOR = 1.48, p = 0.10), ability to walk at 3 months (aOR = 0.69, p = 0.21) or 1-year mortality (adjusted hazard ratio = 1.18, p = 0.27). Conclusion: Significant sex-differences were observed in age, risk factors, access to treatment, and DNRs while no significant differences were observed in comorbidity burden, stroke severity, or hematoma volume. Outcomes, such as adjusted mortality, ability to walk, and neurological deterioration, were comparable. This study supports the presence of sex-differences in risk factors and care but not in presentation and outcomes.
KW - ICH
KW - intracerebral hemorrhage (ICH)
KW - NOAC
KW - oral anticoagulation
KW - sex-differences
KW - stroke
KW - stroke in women
KW - vitamin K-antagonist
U2 - 10.3389/fneur.2022.832903
DO - 10.3389/fneur.2022.832903
M3 - Journal article
C2 - 35309585
AN - SCOPUS:85127117109
VL - 13
JO - Frontiers in Neurology
JF - Frontiers in Neurology
SN - 1664-2295
M1 - 832903
ER -
ID: 309124873