Antikoagulanzienassoziierte Hirnblutungen

Hb, Huttner; Jüttler, Eric; Hug, A.; Köhrmann, Martin; Schellinger, P. D.; Steiner, Thorsten

doi:10.1007/s00115-006-2063-5

Cited by 4 publications

(2 citation statements)

References 95 publications

(148 reference statements)

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“…Contrary to recent investigations reporting higher rates of mortality in patients with elevated troponin levels on admission [10], we did not observe similar associations after applying sophisticated statistical approaches to adjust for confounding [33][34][35]. It remains to be established whether the increased rates of troponin I levels influenced functional outcomes by means of possible secondary cardiac complications or if elevated troponin levels reflect an epiphenomenon of increased comorbidity which -despite strict statistical adjustments -exerted subliminally impact on outcome measures [36]. In ICH patients with pathologically increased troponin values, it seems reasonable to perform prompt cardiac work-up -including ECG, echocardiography, and cardiac catheter examination, if applicable -to differentiate between underlying structural cardiac diseases and stress-induced cardiomyopathy and to consider feasible treatment approaches in those patients.…”

Section: Discussioncontrasting

confidence: 54%

Peak Troponin I Levels Are Associated with Functional Outcome in Intracerebral Hemorrhage

et al. 2018

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Background: Troponin I is a widely used and reliable marker of myocardial damage and its levels are routinely measured in acute stroke care. So far, the influence of troponin I elevations during hospital stay on functional outcome in patients with atraumatic intracerebral hemorrhage (ICH) is unknown. Methods: Observational single-center study including conservatively treated ICH patients over a 9-year period. Patients were categorized according to peak troponin I level during hospital stay (≤0.040, 0.041–0.500, > 0.500 ng/mL) and compared regarding baseline and hematoma characteristics. Multivariable analyses were performed to investigate independent associations of troponin levels during hospital stay with functional outcome – assessed using the modified Rankin Scale (mRS; favorable 0–3/unfavorable 4–6) – and mortality after 3 and 12 months. To account for possible confounding propensity score (PS)-matching (1: 1; caliper 0.1) was performed accounting for imbalances in baseline characteristics to investigate the impact of troponin I values on outcome. Results: Troponin elevations (> 0.040 ng/mL) during hospital stay were observed in 308 out of 745 (41.3%) patients and associated with poorer status on admission (Glasgow Coma Scale/National Institute of Health Stroke Scale). Multivariable analysis revealed troponin I levels during hospital stay to be independently associated with unfavorable outcome after 12 months (risk ratio [95% CI]: 1.030 [1.009–1.051] per increment of 1.0 ng/mL; p = 0.005), but not with mortality. After PS-matching, patients with troponin I elevation (≥0.040 ng/mL) versus those without had a significant higher rate of unfavorable outcome after 3 and 12 months (mRS 4–6 at 3 months: < 0.04 ng/mL: 159/265 [60.0%] versus ≥0.04 ng/mL: 199/266 [74.8%]; p < 0.001; at 12 months: < 0.04 ng/mL: 141/248 [56.9%] versus ≥0.04 ng/mL: 179/251 [71.3%]; p = 0.001). Conclusions: Troponin I elevations during hospital stay occur frequently in ICH patients and are independently associated with functional outcome after 3 and 12 months but not with mortality.

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Section: Discussioncontrasting

confidence: 54%

Peak Troponin I Levels Are Associated with Functional Outcome in Intracerebral Hemorrhage

et al. 2018

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“…ICH in the setting of VKA use is associated with a high mortality ( 44 – 46 ). Subgroup analysis based on indication for VKA reversal (ICH or non-ICH) revealed few significant differences between fixed- and variable-dose regimens in the ICH subgroup.…”

Section: Discussionmentioning

confidence: 99%

Fixed- Versus Variable-Dose Prothrombin Complex Concentrate for the Emergent Reversal of Vitamin K Antagonists: A Systematic Review and Meta-Analysis

Alwakeal,

Maas,

Naidech

et al. 2024

Critical Care Medicine

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Objectives: Four-factor prothrombin complex concentrate (4-PCC) is recommended for rapid reversal of vitamin K antagonists (VKAs) such as warfarin, yet optimal dosing remains uncertain. Data Sources: A systematic review was conducted of PubMed, Embase, and Ovid MEDLINE (Wolters Kluwer) databases from January 2000 to August 2023 for clinical studies comparing fixed- vs. variable-dose 4-PCC for emergent VKA reversal with at least one reported clinical outcome. Study Selection: Abstracts and full texts were assessed independently and in duplicate by two reviewers. Data Extraction: Data were extracted independently and in duplicate by two reviewers using predefined extraction forms. Data Synthesis: The analysis comprised three randomized trials and 16 cohort studies comprising a total of 323 participants in randomized trials (161 in fixed dosage and 162 in variable dosage) and 1912 patients in cohort studies (858 in fixed-dose and 1054 in variable dose). Extracranial bleeding was the predominant indication, while intracranial hemorrhage varied. Overall, a fixed-dose regimen may be associated with a lower dose of 4-PCC and results in a reduction in 4-PCC administration time compared with a variable-dose regimen. A fixed-dose regimen also likely results in increased clinical hemostasis. While there is no clear difference between the two regimens in terms of achieving a goal international normalized ratio (INR) less than 2, a fixed-dose regimen is less likely to achieve a goal INR less than 1.5. High certainty evidence indicates that the fixed-dose regimen reduces both mortality and the occurrence of thromboembolic events. Additional subgroup analyses provides exploratory data to guide future studies. Conclusions: A fixed-dose regimen for 4-PCC administration provides benefits over a variable-dose regimen in terms of dose reduction, faster administration time, improved clinical hemostasis, and reduced mortality and thromboembolic events. Further studies are warranted to better refine the optimal fixed-dose regimen.

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Severe intracranial bleeding related to vitamin K Antagonist‐Ropinirole interaction

et al. 2011

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Antikoagulanzienassoziierte Hirnblutungen

Cited by 4 publications

References 95 publications

Peak Troponin I Levels Are Associated with Functional Outcome in Intracerebral Hemorrhage

Peak Troponin I Levels Are Associated with Functional Outcome in Intracerebral Hemorrhage

Fixed- Versus Variable-Dose Prothrombin Complex Concentrate for the Emergent Reversal of Vitamin K Antagonists: A Systematic Review and Meta-Analysis

Severe intracranial bleeding related to vitamin K Antagonist‐Ropinirole interaction

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