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Abstract

is increased hematoma expansion in patients with delayed or incomplete INR reversal prior to transfer. Methods: Retrospective 32 month single-center review of patients with warfarin-associated intracranial hemorrhage, INR 1.4 or greater upon tertiary center arrival, and treated per an institution-approved warfarin reversal protocol. Patients were excluded from the study if transitioned to palliative care in the first 24 hours or if direct radiologist comparison between images was not available or if surgical intervention was performed that disallowed assessment of hematoma expansion. The presence or absence of hematoma expansion was documented by the radiologist at time of the study. Results: 53 patients met study criteria. 18 patients (34%) transferred from smaller hospitals. 50% of transferred patients had hematoma expansion compared to 11% admitted directly through our hospital emergency department (p=0.002). Average study age was 75. Initial INR did not correlate with incidence of hematoma expansion (mean INR 3.5, no hematoma expansion, INR mean 3.5, with hematoma expansion, p=0.94). Patient variables were analyzed for confounders between the group that was transferred and those that were directly admitted and no differences were noted in baseline INR, gender, bleed location (extra vs intra-axial), and surgical interventions, however the transfer arm was younger (p=0.018). Conclusions:Study suggests delayed INR reversal for hospital transfers leads to significantly higher incidence of hematoma expansion. Expediting INR reversal may limit hematoma expansion and neurologic injury in patients with warfarinassociated intracranial hemorrhage.