Intracerebral Hemorrhagic Expansion Occurs in Patients Using Non–Vitamin K Antagonist Oral Anticoagulants Comparable with Patients Using Warfarin Kara R. Melmed, MD,* Patrick Lyden, MD,* Norman Gellada, R.T.(R)(CT),† and Asma Moheet, MD* , ‡ Background: Non–vitamin K antagonist oral anticoagulant (NOAC) use has signifi- cantly reduced intracerebral hemorrhagic (ICH) risk compared with standard anticoagulant treatment. Hematoma expansion (HE) is a known predictor of mor- tality in warfarin-associated ICH. Little is known about HE in patients using NOACs. Methods: We conducted a retrospective chart review of patients with ICH admitted to Cedars-Sinai Medical Center from October 2010 to June 2016. We identified pa- tients with concomitant administration of an oral anticoagulant and collected data including evidence of HE on imaging and modified Rankin Scale (mRS) at dis- charge. We defined HE as relative (≥33% increase) or absolute expansion (≥12 mL). We compared outcomes of patients with and without HE. Results: Out of 814 pa- tients with ICH who were admitted, we identified 9 patients with recent NOAC use and 18 intentionally matched controls on warfarin. We found no significant dif- ferences in National Institutes of Health Stroke Scale or ICH score on presentation (median [interquartile range] 15 [5,21] versus 7 [1.25,19.5] [P = .41] and 2 [1,4] versus 1 [1,3] [P = .33]) between patients on NOACs and those on warfarin. Four out of the 9 patients on NOAC and 5 of the 18 patients on warfarin demonstrated HE, with no significant difference (P = .42). There were no significant differences in mRS on discharge between groups (P = .52). Conclusions: In our coagulopathic NOAC patient population, HE occurs within 6 hours in 44% of patients. This case series did not have sufficient statistical power to detect significant differences between the groups. To our knowledge, this is one of the largest case series reporting on HE with concomitant NOAC use. Key Words: Critical care—hematoma expansion—intracerebral hemorrhage—novel oral anticoagulants—stroke. © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved. From the *Department of Neurology, Cedars-Sinai Medical Center, LosAngeles, California; †Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, California; and ‡Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California. Received February 7, 2017; revision received March 27, 2017; accepted April 21, 2017. Ethics approval was obtained from the Cedars-Sinai Medical Center institutional review board (IRB). The need for patient consent was waived by the IRB as it is a retrospective analysis. The datasets used or analyzed during the current study are available from the corresponding author on reasonable request. Conflict of interest: Dr Asma Moheet served on the Scientific Advisory Board for Portola Pharmaceuticals. The remaining authors declare that they have no conflict of interest. Author Contributions: K.R.M., acquisition of data, analysis and interpretation of data, authorship of manuscript; P.L., analysis and inter- pretation of data, critical revision of manuscript for intellectual content; N.G., acquisition of data; A.M., study concept and design, study supervision, critical revision of manuscript for intellectual content. All authors report no financial interest. Address correspondence to Kara R. Melmed, MD, Department of Neurology, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Ste. A6600, Los Angeles, CA 90048. E-mail: Kara.Melmed@cshs.org. 1052-3057/$ - see front matter © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2017.04.025 ARTICLE IN PRESS Journal of Stroke and Cerebrovascular Diseases, Vol. ■■, No. ■■ (■■), 2017: pp ■■–■■ 1