Cerebral Vasospasm and Delayed Cerebral Ischemia after Warfarin-Induced Subarachnoid Hemorrhage

Ricarte, Irapuá Ferreira; Calente, Fabrício G.; Alves, Maramelia Miranda; Gomes, Daniela Laranja; Valiente, Raul Alberto; Carvalho, Flávia Chiva; Silva, Gisele Sampaio

doi:10.1016/j.jstrokecerebrovasdis.2015.06.015

Cited by 4 publications

(3 citation statements)

References 11 publications

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“…Patients on anticoagulation may develop SAH on minimal head trauma, therefore it should be excluded. For accurate diagnosis of warfarin induced SAH, presence of intracranial aneurysm or other intracranial vascular abnormality should be excluded through cerebral angiography and magnetic resonance imaging [14] . Our case was in the hospital when he was anticoagulated for acute ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

Warfarin-induced Isolated Spontaneous Subarachnoid Hemorrhage: Rare Case Report

Hassan¹

2022

Preprint

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Subarachnoid hemorrhage (SAH) is mostly associated with head trauma. Non-traumatic subarachnoid hemorrhage is mostly due to vascular abnormalities: either hemorrhage from ruptured aneurysm or bleeding from atriovenous malformation. Aneurysmal hemorrhage is the biggest cause in non-traumatic cases. Warfarin is associated with cerebral intraparenchymal hemorrhage, but it is rarely associated with SAH. Here, we report a case of a 45-year old male patient who was admitted to the neurology ward of our hospital due to acute ischemic stroke. The patient was treated with a vitamin K antagonist (warfarin). However, on the third day, his condition deteriorated (his GCS regressed from 11/15 to 5/15). Pupils were anisocoric. Brain CT done immediately showed extensive subarachnoid hemorrhage without intraparenchymal involvement. The patient was intubated and transferred to the intensive care unit. Due to his poor condition, neurosurgical intervention could not be done. The patient was managed conservatively, but the patient passed away 4 days later in the intensive care unit. Warfarin is rarely associated with subarachnoid hemorrhage, especially when it is only isolated subarachnoid hemorrhage. Aneurismal rupture and trauma should be excluded before diagnosis of warfarin related SAH is made.

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Section: Discussionmentioning

confidence: 99%

Warfarin-induced Isolated Spontaneous Subarachnoid Hemorrhage: Rare Case Report

Hassan¹

2022

Preprint

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“…Patients on anticoagulation may develop SAH with minimal head trauma, therefore it should be excluded. For accurate diagnosis of warfarin-induced SAH, the presence of an intracranial aneurysm or other intracranial vascular abnormality should be excluded through cerebral angiography and magnetic resonance imaging [ 14 ]. Our case was in the hospital when he was anticoagulated for acute ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

Warfarin-induced isolated spontaneous subarachnoid hemorrhage: Rare case report

Hassan¹,

Bakir²,

Adam³

et al. 2022

Annals of Medicine &Amp; Surgery

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“…医学中央雑誌でキーワードを「抗凝固薬関連腎症」「ワルファリン腎症」「ワルファリン関連腎症」（会議録は除く）で検索すると，自験例を含めて6例のARNの報告があった（Table 2）。平均年齢は74歳，男女比は1：1，内服していた抗凝固薬はワルファリン3例，ダビガトラン2例，リバロキサバン1例であった。上述したようにWRNはワルファリンの内服を開始してから早期に発症することが多いと報告されているが，内服開始早期に発症したのは2例のみであった。抗凝固薬の内服期間に関わらずWRN，ARNは発症する可能性がある。6例中4例はCKDの既往歴はなく，発症前の血清クレアチニン値も正常範囲内であった。また6例中3例は腎生検でIgA腎症の併存が指摘されているが，入院後の腎生検で診断されており，いずれも非活性型IgA腎症であった。WRNとIgA腎症との関連が指摘されており，IgA腎症による糸球体透過性変化が，過剰抗凝固に加えて糸球体出血を起こしやすくしている可能性がある 11)。血尿以外の出血性合併症は6例中2例であった。ワルファリンによる出血性合併症は，主に脳出血，消化管出血である。脳出血に関しては小脳出血，皮質・皮質下出血が多い 12)。自験例で認めた胆道出血やSAHの症例報告は少なかった 13), 14)。自験例のPT–INRが他の症例に比して高値であった要因としては，WRNに急性膵炎による凝固障害も併発していたことが可能性として考えられる。…”

Section: 考　　察unclassified

ワルファリンによる抗凝固薬関連腎症の1例(A case of anticoagulant–related nephropathy by warfarin)

啓太,

達也,

有矢

et al. 2023

Nihon Kyukyu Igakukai Zasshi: Japanese Journal of Japanese Asso

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要旨　症例は86歳の女性。心房細動に対してワルファリン内服後に血尿を呈して前医を受診し，ワルファリンによる凝固障害と急性腎障害と診断された。ワルファリン休薬後2日目に心窩部痛を主訴に当院に救急搬送された。当院搬入時も凝固障害があり，胆道内出血と厚生労働省急性膵炎重症度判定基準で予後因子3点以上かつ造影CT grade 2の重症急性膵炎を合併していた。ワルファリン拮抗薬としてメナテトレノン製剤20mgを使用した。急性膵炎に対して輸液，胆道ドレナージや抗菌薬投与を行い，急性腎障害に関しては腎代替療法を行った。くも膜下出血を合併したが，病状は安定し，第17病日に透析を離脱した。凝固障害の改善後の第33病日に腎生検を施行した結果，赤血球円柱による尿細管の閉塞，尿細管上皮細胞傷害の所見を認め，ワルファリン腎症と診断された。その後，第52病日にエドキサバンの内服を開始し，第67病日に胆道ドレーンを抜去し，第77病日にリハビリ目的に転院した。抗凝固薬内服中に凝固障害かつ腎機能障害を呈した場合には抗凝固薬関連腎症も考慮し，迅速な凝固障害の正常化と確定診断のために腎生検を考慮すべきである。

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Cerebral Vasospasm and Delayed Cerebral Ischemia after Warfarin-Induced Subarachnoid Hemorrhage

Cited by 4 publications

References 11 publications

Warfarin-induced Isolated Spontaneous Subarachnoid Hemorrhage: Rare Case Report

Warfarin-induced Isolated Spontaneous Subarachnoid Hemorrhage: Rare Case Report

Warfarin-induced isolated spontaneous subarachnoid hemorrhage: Rare case report

ワルファリンによる抗凝固薬関連腎症の1例(A case of anticoagulant–related nephropathy by warfarin)

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