J Stroke > Volume 19(1); 2017 > Article

Original Article

Journal of Stroke 2017;19(1):67-76.

Published online: January 31, 2017

DOI: https://doi.org/10.5853/jos.2016.00542
Haemorrhagic Transformation after Ischaemic Stroke in Patients Taking Non-vitamin K Antagonist Oral Anticoagulants
Jan C. Purruckera, Kirsten Haasb, Marcel Wolfc, Timolaos Rizosa, Shujah Khana, Peter Kraftd, Sven Polie, Rainer Dziewasf, Johannes Meyneg, Frederick Palmh, Sebastian Janderi, Markus Möhlenbruchc, Peter U. Heuschmannb,j, Roland Veltkampa,k, on behalf of the, RASUNOA investigators

aDepartment of Neurology, Heidelberg University Hospital, Heidelberg, Germany

bInstitute of Clinical Epidemiology and Biometry, University Würzburg, Germany

cDepartment of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany

dDepartment of Neurology, University Hospital Würzburg, Würzburg, Germany

eDepartment of Neurology, Tübingen University, Tübingen, Germany

fDepartment of Neurology, University Hospital Münster, Germany

gDepartment of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany

hDepartment of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany

iDepartment of Neurology, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany

jComprehensive Heart Failure Center, and Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany

kDepartment of Stroke Medicine, Imperial College London, London, United Germany

Correspondence: Roland Veltkamp  Department of Stroke Medicine, Imperial College London, Charing Cross Campus, 3 East 6, Fulham Palace Road, London, W6 8RF, United Kingdom  Phone: +44-20-33130133, Fax: +44-20-83833309, E-mail: r.veltkamp@imperial.ac.uk

Received June 16, 2016 Revised October 11, 2016 Accepted November 28, 2016

Copyright © 2017 Korean Stroke Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract

Background and Purpose
To evaluate the frequency and outcome of haemorrhagic transformation (HT) after ischaemic stroke in patients treated with non-vitamin K antagonist oral anticoagulants (NOACs).
Methods
Patients with stroke on treatment with a NOAC were prospectively enrolled in this multicentre observational study between February 2012 and 2015. Brain imaging at admission and follow-up imaging until day 7 were reviewed for HT. Functional outcome was assessed by the modified Rankin scale (mRS) before the index event, at discharge, and at 3-months.
Results
231 patients without recanalisation therapy (no-RT), and 32 patients with RT were eligible for analysis. Any HT was present at admission in 9/231 no-RT patients (3.9%, 95% CI 2.0 to 7.3) and in none of the patients with RT. In patients with follow-up imaging (no-RT, n=129, and RT, n=32), HT was present in 14.0% (no-RT; 95% CI, 8.9 to 21.1), and 40.6% (RT, 95% CI, 25.5 to 57.8), respectively. After adjustment for stroke severity, this difference between the no-RT and RT groups became non-significant. Symptomatic ICH was observed in 1 patient per group. HT was not associated with unfavourable outcome (mRS 3-6) at 3-months in multivariable analysis. Resumption of OAC after stroke was delayed in patients with HT compared to those without (15 d [IQR, 5–26] vs. 1 d [0–4], P<0.001).
Conclusions
The frequency and severity of HT after stroke on NOAC appears similar to previous reports for vitamin K antagonists and no anticoagulation. Whether asymptomatic HT should delay resumption of preventive anticoagulation requires further investigation.