Anticoagulant treatment as a risk factor for primary intracerebral haemorrhage.

Fogelholm, R; Eskola, Katri; Kiminkinen, T; Kunnamo, Ilkka

doi:10.1136/jnnp.55.12.1121

Cited by 79 publications

(53 citation statements)

References 17 publications

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“…4). 38 Conventional anticoagulation therapy increases the risk of ICH seven-to 10-fold. 47 The use of thrombolytic agents can be complicated by ICH.…”

Section: Risk Factorsmentioning

confidence: 99%

Spontaneous intracerebral hemorrhage: a review

Fewel¹,

Thompson²,

Hoff³

2003

FOC

149

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Spontaneous intracerebral hemorrhage (SICH) is a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. This entity accounts for 10 to 15% of all strokes and is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage. Common causes include hypertension, amyloid angiopathy, coagulopathy, vascular anomalies, tumors, and various drugs. Hypertension, however, remains the single greatest modifiable risk factor for SICH. Computerized tomography scanning is the initial diagnostic modality of choice in SICH, and angiography should be considered in all cases except those involving older patients with preexisting hypertension in thalamic, putaminal, or cerebellar hemorrhage. Medical management includes venous thrombosis prophylaxis, gastric cytoprotection, and aggressive rehabilitation. Anticonvulsant agents should be prescribed in supratentorial SICH, whereas the management of hypertension is controversial. To date, nine prospective randomized controlled studies have been conducted to compare surgical and medical management of SICH. Although definitive evidence favoring surgical intervention is lacking, there is good theoretical rationale for early surgical intervention. Surgery should be considered in patients with moderate to large lobar or basal ganglia hemorrhages and those suffering progressive neurological deterioration. Elderly patients in whom the Glasgow Coma Scale score is less than 5, those with brainstem hemorrhages, and those with small hemorrhages do not typically benefit from surgery. Patients with cerebellar hemorrhages larger than 3 cm, those with brainstem compression and hydrocephalus, or those exhibiting neurological deterioration should undergo surgical evacuation of the clot. It is hoped that the forthcoming results of the International Surgical Trial in IntraCerebral Hemorrhage will help formulate evidence-based recommendations regarding the role of surgery in SICH.

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“…4). 38 Conventional anticoagulation therapy increases the risk of ICH seven-to 10-fold. 47 The use of thrombolytic agents can be complicated by ICH.…”

Section: Risk Factorsmentioning

confidence: 99%

Spontaneous intracerebral hemorrhage: a review

Fewel¹,

Thompson²,

Hoff³

2003

FOC

149

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“…En nuestra serie de 63 pacientes con HE hospitalizados en la unidad de intermedio neurológico, entre Marzo 2001 y Mayo 2004, se presentaron sólo 2 pacientes con HE simultáneas, lo que corresponde a un 3,1%, porcentaje similar al reportado por otros centros (0,7% a 3%) (2)(3)(4)(5)(6)(7)(8)(9) . En las dos pacientes la HE comprometió ambos tálamos en forma simétrica, ubicación más frecuente comprometida en los casos de hemorragias simultáneas (2,5) .…”

Section: Discussionunclassified

“…Ambas pacientes estaban anticoaguladas debido a una fibrilación auricular, lo que aumenta el riesgo de HE en unas 10 veces (8) . El diagnóstico clínico de HE simultánea es difícil.…”

Section: Discussionunclassified

“…En comparación con la HE aislada, la de presentación múltiple y simultánea tiene menor sobrevida y peor pronóstico funcional, incluso si el tamaño de los hematomas es pequeño (8)(9)(10)(11)(12) . Todos los casos de compromiso talámico bilateral reportados en la literatura tuvieron un severo daño neurológico, estado vegetativo o murieron precozmente.…”

Section: Discussionunclassified

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Hematoma talámico bilateral simultáneo: Reporte de dos casos y revisión de la literatura

2006

Rev. chil. neuro-psiquiatr.

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“…Depending on these factors, the annual rate of stroke/embolism varies between 1.0% and 8.9%. 5 From these data, the 69-year-old man, on whom the base case focused, has an annual risk of stroke/embolism of 4.3% if he was without risk factors and of 5.7% if he had Ն1 risk factors.…”

Section: To the Editormentioning

confidence: 99%

Antithrombotic Therapy After Cerebral Hemorrhages

Stöllberger

Finsterer

2003

Stroke

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Oral anticoagulation (OAC) generally increases the likelihood of intracerebral hemorrhage (ICH). When there is an indication for OAC in a patient with a history of ICH, the clinician is in the difficult situation of assessing risks and benefits of OAC. In the absence of data from clinical trials, Eckman et al 1 have used a decision-analysis model to compare the expected values of 3 treatment strategies-OAC, aspirin, and no antithrombotic therapy-in patients with ICH and atrial fibrillation (AF). 1 They conclude that all survivors of lobar ICH and most survivors of deep hemispheric ICH with AF should not be offered OAC. Only patients with deep hemispheric ICH at high risk for stroke or embolism or low risk of ICH recurrence might benefit from OAC. 1 Before these recommendations are integrated into clinical practice, several assumptions in the decision-analysis model have to be clarified:1. The origin of ICH is multifactorial. Some underlying pathologies such as vascular malformations or vasculitis are treatable. For others, no causal treatment is available. Cause and treatment influence the recurrence rate of ICH. Thus, in a patient with ICH and indication for OAC, the ICH origin has to be assessed, as does whether there was any kind of treatment. We miss this kind of evaluation in the model assumptions. Possibly, the assumption is that all "secondary" causes of ICH like vascular malformations, tumors, hemorrhagic infarcts, trauma, and vasculitis have been definitively excluded. If this is the case, it should be stated.2. For patients with lobar ICH, a high annual recurrence rate of 15% is assumed on the basis of 1 study with 71 patients that also included patients with a previous ICH before the index ICH. 2 This rate is much higher than the 0.0% to 5.7% reported by other studies. 3 For patients with deep hemispheric ICH, an annual recurrence rate of 2.1% is assumed on the basis of a review of 4 studies. 3 Why did the authors use data from a single study for calculation of the recurrence rate of lobar ICH and not aggregated data like they have used for deep hemispheric ICH? How would the outcome of the analysis change if the recurrence rate of lobar ICH were assumed to be 5.4%, as suggested by aggregated data? 3 3. The assumption that the site of the index ICH is predictive for the recurrence rate is further modified by a study of 243 patients that found no influences of the site of ICH on the recurrence rate, which was 2.1% per year. 4 4. The effect of OAC on recurrent ICH is assumed as a relative risk of 2. This is rather low in view of the findings of a study in which OAC was initiated in 25 patients after the index ICH and tripled the risk of recurrent ICH. 4 How would the outcome change if a relative risk of 3 were assumed as the effect of OAC on recurrent ICH? 5. It is unclear why an annual risk of stroke of 4.5% is assumed. The risk for stroke/embolism depends on age and the risk factors of hypertension, diabetes, stroke, or transient ischemic attack. Depending on these factors, the annual rate of stroke/e...

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Anticoagulant treatment as a risk factor for primary intracerebral haemorrhage.

Cited by 79 publications

References 17 publications

Spontaneous intracerebral hemorrhage: a review

Spontaneous intracerebral hemorrhage: a review

Hematoma talámico bilateral simultáneo: Reporte de dos casos y revisión de la literatura

Antithrombotic Therapy After Cerebral Hemorrhages

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