Severity and outcomes of intracerebral bleeding and cardiac cerebral embolism

Abstract

Although it is of significant interest and importance for clinical practice to evaluate stroke severity and functional outcome in patients with intracerebral bleeding (ICH) and cardiac cerebral embolism (CCE) occurring during non-vitamin K antagonist oral anticoagulants (NOACs) treatment, clinical research addressing these critical issues in a real-world setting is limited. In this chapter, we discuss these issues by comparing the outcomes of ICH and CCE occurring during warfarin treatment. We and others showed that NOAC-associated ICH may occur in patients at high risk of bleeding events and that even if ICH occurs during NOAC treatment, the size of hematoma is relatively small and hematoma expansion occurs less frequently compared with warfarin-associated ICH. Involvement of microbleeds in NOACassociated ICH and possible underlying mechanisms for favorable outcome of NOAC-associated ICH are still under investigation. On the other hand, there are some reports in the opposite direction showing hematoma expansion and poor clinical outcomes in patients with ICH occurring during NOAC treatment. More studies are warranted. CCE occurring during NOAC treatment was associated with a reduced stroke severity on admission and a favorable functional outcome at discharge, similarly to that during warfarin treatment at a therapeutic range. However, discontinuation of NOAC or its temporary interruption is possibly associated with poor outcome. Therefore, adherence to NOAC and its management is considerably important.