BACKGROUND The objective of this paper is to assess the clinical outcomes between non-traumatic intracerebral hemorrhage(ICH) in patients using direct oral anticoagulants(DOAC) versus vitamin K antagonists(VKA) for non-valvular atrial fibrillation. We also evaluated the predictors of the poor post-ICH outcomes. METHODS We have performed pooled meta-analysis to assess long-term clinical outcomes in patients with DOAC-ICH as compared to those with VKA-ICH. A systematic literature search was conducted by searching the full-text English literature in PubMed, EMBASE, and Cochrane databases for observational studies reporting outcomes on interest. MOOSE guidelines were used to collect data till December 31, 2019 and random effects analysis was carried out to account for heterogeneity. For outcomes, risk ratios(RR) and the mean differences were pooled using a random-effects model and weighted mean differences (WMDs), respectively. RESULTS Seventeen studies met the inclusion criteria (n = 25,354 patients; DOAC-ICH arms = 5,631; VKA-ICH arm = 19,273). Patients with DOAC-ICH had smaller hematoma volumes (WMD=-9.59; 95%CI=-15.33--3.85; I2 = 68.6%) and reduced mortality rate at discharge (RR = 0.82; 95%CI = 0.71-0.96; I2 = 9.4%). There was no significant difference between the two groups in rate of hematoma expansion (RR = 0.79; 95%CI = 0.56-1.11; I2 = 50.9%), unfavorable functional outcome(Modified Rankin Scale) at discharge (RR = 0.82; 95%CI = 0.56-1.18; I2 = 80.2%), unfavorable outcome at 3-months (RR = 0.77; 95%CI = 0.56-1.06; I2 = 63.9), and mortality at 3-months (RR = 0.90; 95%CI = 0.73-1.10; I2 = 35∙8%). Multivariate meta-regression revealed that the average age of patient population had a significantly negative correlation with(RR=-0.202; p = 0.017) hematoma expansion. CONCLUSION We conclude that use of DOAC is associated with reduced hematoma volume and mortality rate at discharge. Age is a predictor of the poor outcome of hematoma expansion.

中文翻译：

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使用直接口服抗凝剂与维生素 K 拮抗剂的患者脑出血结果：荟萃分析

背景本文的目的是评估使用直接口服抗凝剂（DOAC）与维生素 K 拮抗剂（VKA）治疗非瓣膜性心房颤动的非创伤性脑出血（ICH）患者的临床结果。我们还评估了 ICH 后不良结局的预测因素。方法 我们进行了汇总荟萃分析，以评估与 VKA-ICH 患者相比，DOAC-ICH 患者的长期临床结果。通过在 PubMed、EMBASE 和 Cochrane 数据库中搜索报告兴趣结果的观察性研究的全文英文文献，进行了系统的文献搜索。MOOSE 指南用于收集截至 2019 年 12 月 31 日的数据，并进行随机效应分析以考虑异质性。对于结果，分别使用随机效应模型和加权平均差异 (WMD) 合并风险比 (RR) 和平均差异。结果 17 项研究符合纳入标准（n = 25,354 名患者；DOAC-ICH 组 = 5,631；VKA-ICH 组 = 19,273）。DOAC-ICH 患者的血肿体积较小（WMD=-9.59；95%CI=-15.33--3.85；I2=68.6%）并且出院时死亡率降低（RR=0.82；95%CI=0.71-0.96；I2） = 9.4%）。两组血肿扩大率（RR = 0.79；95%CI = 0.56-1.11；I2 = 50.9%）、出院时不良功能结局（改良Rankin量表）（RR = 0.82；95%）无显着差异CI = 0.56-1.18；I2 = 80.2%），3 个月时不良结果（RR = 0.77；95%CI = 0.56-1.06；I2 = 63.9），3 个月死亡率（RR = 0.90；95%CI） = 0.73-1.10；I2 = 35∙8%）。多元元回归显示患者人群的平均年龄与（RR=-0.202；p=0.017）血肿扩大呈显着负相关。结论 我们得出的结论是，使用 DOAC 与出院时血肿体积减少和死亡率降低有关。年龄是血肿扩大预后不良的预测因素。