September 12, 2017; 89 (11) Article
Direct oral anticoagulant– vs vitamin K antagonist–related nontraumatic intracerebral hemorrhage
Georgios Tsivgoulis, Vasileios-Arsenios Lioutas, Panayiotis Varelas, Aristeidis H. Katsanos, Nitin Goyal, Robert Mikulik, Kristian Barlinn, Christos Krogias, Vijay K. Sharma, Konstantinos Vadikolias, Efthymios Dardiotis, Theodore Karapanayiotides, Alexandra Pappa, Christina Zompola, Sokratis Triantafyllou, Odysseas Kargiotis, Michael Ioakeimidis, Sotirios Giannopoulos, Ali Kerro, Argyrios Tsantes, Chandan Mehta, Mathew Jones, Christoph Schroeder, Casey Norton, Anastasios Bonakis, Jason Chang, Anne W. Alexandrov, Panayiotis Mitsias, Andrei V. Alexandrov
First published August 16, 2017, DOI: https://doi.org/10.1212/WNL.0000000000004362
Georgios Tsivgoulis
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Vasileios-Arsenios Lioutas
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Panayiotis Varelas
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Aristeidis H. Katsanos
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Nitin Goyal
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Robert Mikulik
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Kristian Barlinn
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Christos Krogias
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Vijay K. Sharma
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Konstantinos Vadikolias
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Efthymios Dardiotis
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Theodore Karapanayiotides
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Alexandra Pappa
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Christina Zompola
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Sokratis Triantafyllou
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Odysseas Kargiotis
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Michael Ioakeimidis
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Sotirios Giannopoulos
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Ali Kerro
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Argyrios Tsantes
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Chandan Mehta
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Mathew Jones
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Christoph Schroeder
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Casey Norton
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Anastasios Bonakis
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Jason Chang
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Anne W. Alexandrov
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Panayiotis Mitsias
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Andrei V. Alexandrov
From the Department of Neurology (G.T., N.G., A.K., J.C., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., S.T., M.I., A.B.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (V.-A.L., C.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurology (P.V., C.M., M.J., P.M.), Henry Ford Hospital, Detroit, MI; Department of Neurology (A.H.K., S.G.), University of Ioannina School of Medicine, Greece; International Clinical Research Center (R.M.), Neurology Department, St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.B.), Dresden University Stroke Center; Department of Neurology (C.K., C.S.), St. Josef-Hospital, Ruhr University of Bochum, Germany; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (K.V.), Democritus University of Thrace, Alexandroupolis, Greece; Department of Neurology (E.D., A.P.), University of Thessaly, Larissa; Second Department of Neurology (T.K.), AHEPA University Hospital, Aristotelian University of Thessaloniki; Acute Stroke Unit (O.K.), Metropolitan Hospital, Piraeus; Laboratory of Haematology and Blood Bank Unit (A.T.), “Attikon” Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia; and Department of Neurology (P.M.), University of Crete, Heraklion, Greece.
Direct oral anticoagulant– vs vitamin K antagonist–related nontraumatic intracerebral hemorrhage
Georgios Tsivgoulis, Vasileios-Arsenios Lioutas, Panayiotis Varelas, Aristeidis H. Katsanos, Nitin Goyal, Robert Mikulik, Kristian Barlinn, Christos Krogias, Vijay K. Sharma, Konstantinos Vadikolias, Efthymios Dardiotis, Theodore Karapanayiotides, Alexandra Pappa, Christina Zompola, Sokratis Triantafyllou, Odysseas Kargiotis, Michael Ioakeimidis, Sotirios Giannopoulos, Ali Kerro, Argyrios Tsantes, Chandan Mehta, Mathew Jones, Christoph Schroeder, Casey Norton, Anastasios Bonakis, Jason Chang, Anne W. Alexandrov, Panayiotis Mitsias, Andrei V. Alexandrov
Neurology Sep 2017, 89 (11) 1142-1151; DOI: 10.1212/WNL.0000000000004362
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Abstract
Objective: To compare the neuroimaging profile and clinical outcomes among patients with intracerebral hemorrhage (ICH) related to use of vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF).
Methods: We evaluated consecutive patients with NVAF with nontraumatic, anticoagulant-related ICH admitted at 13 tertiary stroke care centers over a 12-month period. We also performed a systematic review and meta-analysis of eligible observational studies reporting baseline characteristics and outcomes among patients with VKA- or DOAC-related ICH.
Results: We prospectively evaluated 161 patients with anticoagulation-related ICH (mean age 75.6 ± 9.8 years, 57.8% men, median admission NIH Stroke Scale [NIHSSadm] score 13 points, interquartile range 6–21). DOAC-related (n = 47) and VKA-related (n = 114) ICH did not differ in demographics, vascular risk factors, HAS-BLED and CHA2DS2-VASc scores, and antiplatelet pretreatment except for a higher prevalence of chronic kidney disease in VKA-related ICH. Patients with DOAC-related ICH had lower median NIHSSadm scores (8 [3–14] vs 15 [7–25] points, p = 0.003), median baseline hematoma volume (12.8 [4–40] vs 24.3 [11–58.8] cm3, p = 0.007), and median ICH score (1 [0–2] vs 2 [1–3] points, p = 0.049). Severe ICH (>2 points) was less prevalent in DOAC-related ICH (17.0% vs 36.8%, p = 0.013). In multivariable analyses, DOAC-related ICH was independently associated with lower baseline hematoma volume (p = 0.006), lower NIHSSadm scores (p = 0.022), and lower likelihood of severe ICH (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.13–0.87, p = 0.025). In meta-analysis of eligible studies, DOAC-related ICH was associated with lower baseline hematoma volumes on admission CT (standardized mean difference = −0.57, 95% CI −1.02 to −0.12, p = 0.010) and lower in-hospital mortality rates (OR = 0.44, 95% CI 0.21–0.91, p = 0.030).
Conclusions: DOAC-related ICH is associated with smaller baseline hematoma volume and lesser neurologic deficit at hospital admission compared to VKA-related ICH.
GLOSSARY
- CI=
- confidence interval;
- CMB=
- cerebral microbleed;
- CMB-NOW=
- Cerebral Microbleeds During the Non-Vitamin K Antagonist Oral Anticoagulants or Warfarin Therapy in Stroke Patients With Nonvalvular Atrial Fibrillation;
- DOAC=
- direct oral anticoagulant;
- ICH=
- intracranial hemorrhage;
- INR=
- international normalized ratio;
- IQR=
- interquartile range;
- MOOSE=
- Meta-Analysis of Observational Studies Epidemiology;
- mRS=
- modified Rankin Scale;
- NIHSS=
- NIH Stroke Scale;
- NVAF=
- nonvalvular atrial fibrillation;
- OR=
- odds ratio;
- PRISMA=
- Preferred Reporting Items for Systematic Reviews and Meta-Analyses;
- RE-LY=
- Randomized Evaluation of Long-Term Anticoagulation Therapy;
- ROCKET AF=
- Rivaroxaban Once-Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation;
- VKA=
- vitamin K antagonist
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received March 1, 2017.
- Accepted in final form June 19, 2017.
- © 2017 American Academy of Neurology
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