PMID- 37028263
OWN - NLM
STAT- MEDLINE
DCOM- 20230418
LR  - 20230424
IS  - 1878-5883 (Electronic)
IS  - 0022-510X (Linking)
VI  - 448
DP  - 2023 May 15
TI  - Vitamin K antagonists but not non-vitamin K antagonists in addition on 
      antiplatelet therapy should be associated with increase of hematoma volume and 
      mortality in patients with intracerebral hemorrhage: A sub-analysis of PASTA 
      registry study.
PG  - 120643
LID - S0022-510X(23)00103-X [pii]
LID - 10.1016/j.jns.2023.120643 [doi]
AB  - BACKGROUND AND PURPOSE: Prior concomitant use of vitamin K antagonists (VKAs) and 
      antiplatelet (AP) therapy increase the hematoma volume and mortality compared 
      with VKA monotherapy in patients with intracranial hemorrhage (ICH). However, the 
      prior concomitant use of non-vitamin K oral antagonists (NOACs) and AP has not 
      been clarified. METHODS: We conducted a PASTA registry study, which was an 
      observational, multicenter, registry of 1043 patients with stroke receiving oral 
      anticoagulants (OACs) in Japan. In the present study, ICH from the PASTA registry 
      was used to analyze the clinical characteristics including mortality among the 
      four groups (NOAC, VKA, NOAC and AP, and VKA and AP) using univariate and 
      multivariate analyses. RESULTS: Among the 216 patients with ICH, 118 (54.6%), 27 
      (12.5%), 55 (25.5%), 16 (7.4%) were taking NOAC monotherapy, NOAC and AP, VKA, 
      and VKA and AP, respectively. In-hospital mortality rates were the highest in VKA 
      and AP (31.3%) than in NOACs (11.9%), NOACs and AP (7.4%), and VKA (7.3%). 
      Multivariate logistic regression analysis demonstrated that the concomitant use 
      of VKA and AP (odds ratio [OR], 20.57; 95% confidence interval [CI], 1.75-241.75, 
      p = 0.0162), initial National Institutes of Health Stroke Scale score (OR, 1.21; 
      95%CI, 1.10-1.37, p < 0.0001), hematoma volume (OR, 1.41; 95%CI, 1.10-1.90, 
      p = 0.066), and systolic blood pressure (OR, 1.31; 95%CI, 1.00-1.75, p = 0.0422) 
      were independently associated with in-hospital mortality. CONCLUSIONS: Although 
      VKA in addition to AP therapy could increase the in-hospital mortality, NOAC and 
      AP did not increase the hematoma volume, stroke severity, or mortality compared 
      to NOAC monotherapy.
CI  - Copyright (c) 2023 Elsevier B.V. All rights reserved.
FAU - Nomura, Koichi
AU  - Nomura K
AD  - Department of Neurology, Nippon Medical School, Tokyo, Japan; Department of 
      Neurology, Shioda Hospital, Chiba, Japan. Electronic address: k.nomura@nms.ac.jp.
FAU - Suda, Satoshi
AU  - Suda S
AD  - Department of Neurology, Nippon Medical School, Tokyo, Japan.
FAU - Abe, Arata
AU  - Abe A
AD  - Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical 
      Center, Tokyo, Japan.
FAU - Iguchi, Yasuyuki
AU  - Iguchi Y
AD  - Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan.
FAU - Yagita, Yoshiki
AU  - Yagita Y
AD  - Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan.
FAU - Kanzawa, Takao
AU  - Kanzawa T
AD  - Department of Stroke Medicine, Institute of Brain and Blood Vessels, Mihara 
      Memorial Hospital, Gunma, Japan; Institute of HM net work, Gunyukai Isesaki 
      Clinic, Gunma, Japan.
FAU - Okubo, Seiji
AU  - Okubo S
AD  - Department of Cerebrovascular Medicine, NTT Medical Center Tokyo, Tokyo, Japan.
FAU - Fujimoto, Shigeru
AU  - Fujimoto S
AD  - Division of Neurology, Department of Medicine, Jichi Medical University Hospital, 
      Tochigi, Japan.
FAU - Kimura, Kazumi
AU  - Kimura K
AD  - Department of Neurology, Nippon Medical School, Tokyo, Japan.
CN  - PASTA study group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20230401
PL  - Netherlands
TA  - J Neurol Sci
JT  - Journal of the neurological sciences
JID - 0375403
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Fibrinolytic Agents)
SB  - IM
MH  - Humans
MH  - Anticoagulants/adverse effects
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Administration, Oral
MH  - Cerebral Hemorrhage/diagnostic imaging/drug therapy/chemically induced
MH  - Hematoma/diagnostic imaging/drug therapy
MH  - Intracranial Hemorrhages/chemically induced
MH  - Registries
MH  - Fibrinolytic Agents/therapeutic use
MH  - *Stroke/diagnostic imaging/drug therapy
MH  - *Atrial Fibrillation/drug therapy
OTO - NOTNLM
OT  - Antiplatelet therapy
OT  - Atrial fibrillation
OT  - Intracerebral hemorrhage
OT  - Non-vitamin K oral antagonists
OT  - Oral anticoagulants
OT  - Vitamin K antagonists
EDAT- 2023/04/08 06:00
MHDA- 2023/04/18 06:41
CRDT- 2023/04/07 18:14
PHST- 2022/05/23 00:00 [received]
PHST- 2023/02/09 00:00 [revised]
PHST- 2023/03/31 00:00 [accepted]
PHST- 2023/04/18 06:41 [medline]
PHST- 2023/04/08 06:00 [pubmed]
PHST- 2023/04/07 18:14 [entrez]
AID - S0022-510X(23)00103-X [pii]
AID - 10.1016/j.jns.2023.120643 [doi]
PST - ppublish
SO  - J Neurol Sci. 2023 May 15;448:120643. doi: 10.1016/j.jns.2023.120643. Epub 2023 
      Apr 1.