Abstract：
Objective-Direct oral anticoagulants (DOAC) are replacing vitamin K antagonists (VKA) for the prevention of ischemic stroke and venous thromboembolism. We set out to assess the effect of prior treatment with DOAC and VKA in patients with aneurysmal subarachnoid hemorrhage (SAH). Methods-Consecutive SAH patients treated at two (Aachen, Germany and Helsinki, Finland) university hospitals were considered for inclusion. To assess the association between anticoagulant treatments on SAH severity measure by modified Fisher grading (mFisher) and outcome as measured by the Glasgow outcome scale (GOS, 6 months), DOAC- and VKA-treated patients were compared against age- and sex-matched SAH controls without anticoagulants. Results-During the inclusion timeframes, 964 SAH patients were treated in both centers. At the time point of aneurysm rupture, nine patients (0.93%) were on DOAC treatment, and 15 (1.6%) patients were on VKA. These were matched to 34 and 55 SAH age- and sex-matched controls, re-spectively. Overall, 55.6% of DOAC-treated patients suffered poor-grade (WFNS4-5) SAH compared to 38.2% among their respective controls (p = 0.35); 53.3% of patients on VKA suffered poor-grade SAH compared to 36.4% in their respective controls (p = 0.23). Neither treatment with DOAC (aOR 2.70, 95%CI 0.30 to 24.23; p = 0.38), nor VKA (aOR 2.78, 95%CI 0.63 to 12.23; p = 0.18) were inde-pendently associated with unfavorable outcome (GOS1-3) after 12 months. Conclusions-Iatrogenic coagulopathy caused by DOAC or VKA was not associated with more severe radiological or clinical subarachnoid hemorrhage or worse clinical outcome in hospitalized SAH patients.
摘要：
目的：直接口服抗凝药（DOAC）替代维生素K拮抗剂（VKA）预防缺血性卒中和静脉血栓栓塞。我们着手评估DOAC和VKA对动脉瘤性蛛网膜下腔出血（SAH）患者的治疗效果。方法-连续两次治疗的SAH患者（亚琛，德国和赫尔辛基，芬兰)大学医院被考虑纳入。通过改良的Fisher分级（mFisher）评估SAH严重程度的抗凝治疗与格拉斯哥结局量表（GOS，6个月),将DOAC和VKA治疗的患者与年龄和性别匹配的无抗凝剂的SAH对照进行比较。结果-在纳入时间范围内，两个中心都对964例SAH患者进行了治疗。在动脉瘤破裂的时间点，9名患者（0.93%）接受DOAC治疗，15例（1.6％）患者接受VKA。这些与34和55个年龄和性别匹配的SAH对照相匹配，分别。总的来说,55.6％的DOAC治疗患者患有不良等级（WFNS4-5）SAH，而各自的对照组为38.2％（p=0.35）；VKA的53.3％的患者患有不良等级SAH，而各自的对照组为36.4％（p=0.23）。均未使用DOAC治疗（aOR2.70，95CI0.30至24.23；p=0.38），VKA（aOR2.78，95CI0.63至12.23；p=0.18）与12个月后的不良结局（GOS1-3）无关。结论：在住院SAH患者中，DOAC或VKA引起的医源性凝血病与更严重的放射学或临床蛛网膜下腔出血或更差的临床预后无关。
