Atrial fibrillation patients who sustained warfarin-associated intracerebral haemorrhage have poor neurological outcomes: results from a matched case series

Fong, M.K.; Sheng, Bao-Ying; Chu, Yim Pui; Wong, WT; Lau, Patrick Pk; Wong, Hon Tym; Lau, K.T.

doi:10.12809/hkmj164953

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…8,17,23,24 In our study, one third of patients had admission INR >3.0, whereas INR <2.0 was found in only 16% of patients in both groups, values in line with previous studies. 25,26 Unexpectedly, median INR levels were similar between patients with traumatic and spontaneous hemorrhage.…”

Section: Admission Inrmentioning

confidence: 88%

Traumatic and spontaneous intracranial hemorrhage in atrial fibrillation patients on warfarin

et al. 2018

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Section: Admission Inrmentioning

confidence: 88%

Traumatic and spontaneous intracranial hemorrhage in atrial fibrillation patients on warfarin

et al. 2018

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“…Unfortunately, the risk of ICH recurrence in patients receiving anticoagulation is not clear. Fong et al showed in a recent study that increased ICH mortality was associated with patients on warfarin for atrial fibrillation, however, there are no population-based studies as of yet [13]. ICH recurrence risk in general is about 2% to 4% per patient-year, while the risk of suffering a major bleed on warfarin therapy is about 2% to 3% per year and may be higher in the first month.…”

Section: Discussionmentioning

confidence: 99%

Treating Venous Thromboembolism Post Intracranial Hemorrhage: A Case Report

Ajmeri

Zaheer

McCorkle

et al. 2020

Cureus

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Venous thromboembolism (VTE) is a significant issue occurring due to genetic, acquired and circumstantial risk factors. Treatment is according to the clinical situation and judgment for long term anticoagulation based on individual risk. Anticoagulation after a history of a hemorrhagic stroke poses a therapeutic dilemma. We present a case of a 68-year-old male who presented with right-sided chest pain and shortness of breath. Workup included a CT that was positive for multiple right-sided pulmonary emboli (PE). The patient has a past medical history of Factor V Leiden Mutation, recurrent PE, and deep vein thrombosis (DVT). Two months prior he was diagnosed with a 1.3-cm intracranial hemorrhage (ICH) from multiple cavernous angiomas. At that time his warfarin was discontinued and an inferior vena cave (IVC) filter was placed. Facing the recent ICH and now multiple and recurrent PE, it was decided to resume anticoagulation based on ICH location. ICH from a deep source is likely a better characteristic that favors a resumption of anticoagulation. Our case will highlight that IVC filters cannot be solely relied upon in patients that are at high risk for thrombotic events with underlying genetic thrombophilia.

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“…16,[18][19][20] According to the 1993-2006 data retrieved from the Adverse Event Reporting System of the Food and Drug Administration in the United States, a total of 9766 warfarin-related bleeding cases were reported, among which 86% of cases had serious results, whereas 10% of cases resulted in death. 21 Moreover, Fong et al 22 indicated that patients with warfarin-related intracerebral hemorrhage were more likely to have a higher hospital mortality rate.…”

mentioning

confidence: 99%

The Effects of Educational Programs on Knowledge, International Normalized Ratio, Warfarin Adherence, and Warfarin-Related Complications in Patients Receiving Warfarin Therapy

Wong

Hong

2021

J Cardiovasc Nurs

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BackgroundEducation is considered a crucial element in anticoagulation management for patients with atrial fibrillation, valvular disease, ischemic heart disease, and venous thromboembolism. However, the effects of education on the patients prescribed warfarin are seldom investigated.ObjectivesThis integrative review was conducted to explore the effects of educational programs on patients prescribed warfarin for the aforementioned cardiovascular diseases and to identify the components of effective programs.MethodsA systematic search of clinical trials was performed in 8 databases from inception to August 2020. Two reviewers performed the eligibility assessment, methodological evaluation, and data extraction. A total of 9 studies were included and analyzed via narrative synthesis.ResultsNine studies involving a combined total of 1335 patients were included in the review. The findings suggest that educational programs have potential benefits related to international normalized ratio control and warfarin knowledge. However, their effects on major bleeding and thromboembolic events are unremarkable. Stronger evidence is recommended to confirm these findings, and the limited evidence examining the effects of education on warfarin adherence, minor bleeding, abnormal international normalized ratio, readmission rate, and warfarin-related mortality requires further exploration. Verbal education supported by written materials was the main educational delivery mode. A lecture length of approximately 45 minutes was likely appropriate. Notably, the integration of educational strategies, application of follow-up interventions and monitoring measures, adoption of psychological theories in program development, and inclusion of nurses or pharmacists in program conduction seemed to be effective program components.ConclusionsThe effects of educational programs on patients prescribed warfarin mainly for atrial fibrillation, valvular disease, ischemic heart disease, and venous thromboembolism remain inconclusive. Further research using randomized controlled trials is warranted.

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Atrial fibrillation patients who sustained warfarin-associated intracerebral haemorrhage have poor neurological outcomes: results from a matched case series

Cited by 3 publications

References 23 publications

Traumatic and spontaneous intracranial hemorrhage in atrial fibrillation patients on warfarin

Traumatic and spontaneous intracranial hemorrhage in atrial fibrillation patients on warfarin

Treating Venous Thromboembolism Post Intracranial Hemorrhage: A Case Report

The Effects of Educational Programs on Knowledge, International Normalized Ratio, Warfarin Adherence, and Warfarin-Related Complications in Patients Receiving Warfarin Therapy

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