Comparison of Outcomes: DOAC vs. Warfarin in Intracerebral Hemorrhage, Study notes of Voice

Data on the comparison of outcomes between patients who experienced intracerebral hemorrhage (ICH) while taking direct oral anticoagulants (DOAC) or warfarin. The data includes consciousness level grading using the Japan Coma Scale, interaction analysis between DOAC and reversal agents on ICH removal, hemorrhage location, patient characteristics, and mortality rates. The analysis was conducted using logistic regressions and propensity score matching.

Typology: Study notes

2021/2022

Uploaded on 09/27/2022

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Table e-1. Japan Coma Scale for grading impaired consciousness*
Grade Consciousness Level
1-digit code The patient is awake without any stimuli, and is:
1 Almost fully conscious
2 Unable to recognize time, place, and person
3 Unable to recall name or date of birth
2-digit code
The patient can be aroused (then reverts to previous state after
cessation of stimulation):
10
By easily by being spoken to (or is responsive with purposeful
movements, phrases, or words)†
20 With a loud voice or shaking of
shoulders (or is almost always
responsive to very simple words like yes or no or to movements)
30 Only by repeated mechanical stimuli
3-digit code The patient cannot be aroused with any forceful mechanical stimuli,
and:
100 Responds with movements to avoid the stimulus
200
Responds with slight movements, including decerebrate and
decorticate posture
300 Does not respond at all except for changes in respiratory rhythm
*"R" and "I" are added to the grade to indicate restlessness and incontinence of urine
and feces, respectively: for example; 100-R and 30-RI.
Criteria in parentheses are used in patients who cannot open their eyes for any reason
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Table e-1. Japan Coma Scale for grading impaired consciousness* Grade Consciousness Level 1-digit code The patient is awake without any stimuli, and is: 1 Almost fully conscious 2 Unable to recognize time, place, and person 3 Unable to recall name or date of birth 2-digit code The patient can be aroused (then reverts to previous state after cessation of stimulation): 10 By easily by being spoken to (or is responsive with purposeful movements, phrases, or words)† 20 With a loud voice or shaking of shoulders (or is almost always responsive to very simple words like yes or no or to movements) 30 Only by repeated mechanical stimuli 3-digit code The patient cannot be aroused with any forceful mechanical stimuli, and: 100 Responds with movements to avoid the stimulus 200 Responds with slight movements, including decerebrate and decorticate posture 300 Does not respond at all except for changes in respiratory rhythm

*"R" and "I" are added to the grade to indicate restlessness and incontinence of urine and feces, respectively: for example; 100-R and 30-RI. †Criteria in parentheses are used in patients who cannot open their eyes for any reason

Table e-2. The interaction analysis between usage of DOAC and reversal agents on ICH removal by logistic regressions.

OR 95% CI P value Usage of DOAC Usage of reversal agents

Interaction between DOAC and reversal agents 5.02 0.92-27.28 0.

Abbreviations: OR, odds ratio; CI, Confidence interval; DOAC, direct oral anticoagulants

Table e-4. Characteristics of DOAC and warfarin-associated ICH patients matched by propensity score.

Variable DOAC Warfarin n=221 n= Mean or % P value Male 76.5 74.7 0. Age 73.3 74.5 0. Charlson score 4.8 4.9 0. Hypertension 60.6 56.1 0. Diabetes mellitus 26.7 23.1 0. Hyperlipidemia 14.0 12.2 0. JCS score 2 or 3-digit code 26.7 30.8 0. Concurrent antiplatelet therapy 24.4 25.8 0. ICH removal 5.9 5.4 0. External CSF drainage 2.7 2.3 0. Vitamin_K 2.7 2.7 1 PCC 5.0 2.7 0. FFP 5.4 3.6 0.

Abbreviations: DOAC, direct oral anticoagulants; ICH, intracerebral hemorrhage; CSF, cerebrospinal fluid; PCC, prothrombin complex concentrate; FFP, Fresh frozen plasma

Table e-5. ORs of mortality within 1 day, 7 days and during hospitalization, and mRS 4-6 at discharge in warfarin-associated ICH patients compared with dabigatran-associated ICH patients after matching by propensity score.

OR 95% CI P value Mortality within 1 day 2.44 0.32-18.42 0. Mortality within 7 days 1.45 0.26-8.14 0. In-hospital mortality 2.11 0.47-9.45 0. Discharge mRS 4-6 1.02 0.35-3.00 0.

Abbreviations: OR, odds ratio; CI, Confidence interval; mRS, modified Rankin Scale; DOAC, direct oral anticoagulants

Table e-7. ORs of mortality within 1 day, 7 days and during hospitalization, and mRS 4-6 at discharge in warfarin-associated ICH patients compared with rivaroxaban-associated ICH patients after matching by propensity score.

OR 95% CI P value Mortality within 1 day 11.22 1.40-90.27 0. Mortality within 7 days 2.23 0.94-5.31 0. In-hospital mortality 1.48 0.73-3.00 0. Discharge mRS 4-6 0.45 0.17-1.15 0.

Abbreviations: OR, odds ratio; CI, Confidence interval; mRS, modified Rankin Scale