Sex-Differences in Oral Anticoagulant-Related Intracerebral Hemorrhage

Josefine Grundtvig; Christian Ovesen; Thorsten Steiner; Cheryl Carcel; David Gaist; Louisa Christensen; Jacob Marstrand; Per Meden; Sverre Rosenbaum; Helle K Iversen; Christina Kruuse; Thomas Christensen; Karen Ægidius; Inger Havsteen; Hanne Christensen

doi:10.3389/fneur.2022.832903

Sex-Differences in Oral Anticoagulant-Related Intracerebral Hemorrhage

Josefine Grundtvig, Christian Ovesen, Thorsten Steiner, Cheryl Carcel, David Gaist, Louisa Christensen, Jacob Marstrand, Per Meden, Sverre Rosenbaum, Helle K Iversen, Christina Kruuse, Thomas Christensen, Karen Ægidius, Inger Havsteen, Hanne Christensen

6 Citations (Scopus)

Abstract

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.

Original language	English
Article number	832903
Journal	Frontiers in Neurology
Volume	13
Pages (from-to)	832903
ISSN	1664-2295
DOIs	https://doi.org/10.3389/fneur.2022.832903
Publication status	Published - 3 Mar 2022

Keywords

ICH
NOAC
intracerebral hemorrhage (ICH)
oral anticoagulation
sex-differences
stroke
stroke in women
vitamin K-antagonist

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10.3389/fneur.2022.832903

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Grundtvig, J., Ovesen, C., Steiner, T., Carcel, C., Gaist, D., Christensen, L., Marstrand, J., Meden, P., Rosenbaum, S., Iversen, H. K., Kruuse, C., Christensen, T., Ægidius, K., Havsteen, I., & Christensen, H. (2022). Sex-Differences in Oral Anticoagulant-Related Intracerebral Hemorrhage. Frontiers in Neurology, 13, 832903. Article 832903. https://doi.org/10.3389/fneur.2022.832903

@article{173c5b61ac294ec590195e0b1d7422e7,

title = "Sex-Differences in Oral Anticoagulant-Related Intracerebral Hemorrhage",

abstract = "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.",

keywords = "ICH, NOAC, intracerebral hemorrhage (ICH), oral anticoagulation, sex-differences, stroke, stroke in women, vitamin K-antagonist",

author = "Josefine Grundtvig and Christian Ovesen and Thorsten Steiner and Cheryl Carcel and David Gaist and Louisa Christensen and Jacob Marstrand and Per Meden and Sverre Rosenbaum and Iversen, {Helle K} and Christina Kruuse and Thomas Christensen and Karen {\AE}gidius and Inger Havsteen and Hanne Christensen",

note = "Copyright {\textcopyright} 2022 Grundtvig, Ovesen, Steiner, Carcel, Gaist, Christensen, Marstrand, Meden, Rosenbaum, Iversen, Kruuse, Christensen, {\AE}gidius, Havsteen and Christensen.",

year = "2022",

month = mar,

day = "3",

doi = "10.3389/fneur.2022.832903",

language = "English",

volume = "13",

pages = "832903",

journal = "Frontiers in Neurology",

issn = "1664-2295",

publisher = "Frontiers Research Foundation",

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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

PY - 2022/3/3

Y1 - 2022/3/3

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 - NOAC

KW - intracerebral hemorrhage (ICH)

KW - oral anticoagulation

KW - sex-differences

KW - stroke

KW - stroke in women

KW - vitamin K-antagonist

UR - http://www.scopus.com/inward/record.url?scp=85127117109&partnerID=8YFLogxK

U2 - 10.3389/fneur.2022.832903

DO - 10.3389/fneur.2022.832903

M3 - Journal article

C2 - 35309585

SN - 1664-2295

VL - 13

SP - 832903

JO - Frontiers in Neurology

JF - Frontiers in Neurology

M1 - 832903

ER -

Sex-Differences in Oral Anticoagulant-Related Intracerebral Hemorrhage

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