Determinants of Outcome in Anticoagulation-Associated Cerebral Hematoma Requiring Emergency Evacuation

Rabinstein, Alejandro A.; Wijdicks, Eelco F. M.

doi:10.1001/archneur.64.2.noc60131

Cited by 17 publications

(9 citation statements)

References 9 publications

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“…Due to the retrospective study design we do not have recanalization data and also did not systematically collect information regarding hyperdense MCA signs which have been shown to predict outcome in large rtPA registries [29]. The poor functional outcome of patients with a low combined score may have partially been due to a self-fulfilling prophecy as physicians may have limited patient care in early treatment phases due to expectation of a poor functional outcome [30,31]. We included patients who received additional IA therapies after initiation of IV thrombolysis.…”

Section: Discussionmentioning

confidence: 99%

Malignant Profile Detected by CT Angiographic Information Predicts Poor Prognosis despite Thrombolysis within Three Hours from Symptom Onset

et al. 2010

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Objective: A malignant profile of early brain ischemia has been demonstrated in the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) trial. Patients with a malignant profile had a low chance for an independent functional outcome despite thrombolysis within 3–6 h. We sought to determine whether CT angiography (CTA) could identify a malignant imaging profile within 3 h from symptom onset. Methods: We studied consecutive patients (04/02–09/07) with anterior circulation stroke who received CTA before intravenous thrombolysis within 3 h. We assessed the Alberta Stroke Program Early CT Score (ASPECTS) on CTA source images (CTASI). Intracranial thrombus burden on CTA was assessed with a novel 10-point clot burden score (CBS). We analyzed percentages independent (modified Rankin Scale score ≤2) and fatal outcome at 3 months and parenchymal hematoma rates across categorized combined CTASI-ASPECTS + CBS score groups where 20 is best and 0 is worst. Results: We identified 114 patients (median age 73 years [interquartile range 61–80], onset-to-tPA time 129 min [95–152]). Among 24 patients (21%) with extensive hypoattenuation on CTASI and extensive thrombus burden (combined score ≤10), only 4% (1/24) were functionally independent whereas mortality was 50% (12/24). In contrast, 57% (51/90) of patients with less affected scores (combined score 11–20) were functionally independent and mortality was 10% (9/90; p < 0.001). Parenchymal hematoma rates were 30% (7/23) vs. 8% (7/88), respectively (p = 0.008). Conclusion: CTA identifies a large hyperacute stroke population with high mortality and low likelihood for independent functional outcome despite early thrombolysis.

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Section: Discussionmentioning

confidence: 99%

Malignant Profile Detected by CT Angiographic Information Predicts Poor Prognosis despite Thrombolysis within Three Hours from Symptom Onset

et al. 2010

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“…Rapid reversal of INR has also permits urgent surgical evacuations in neurologically deteriorating patients with anticoagulant related ICH. Early reversal and evacuation was associated with a high rate (65%) of favorable outcomes in patients with a prominent midline shift (with or without TTH) in one study [113].…”

Section: A Rapid Inr Reversal (Within 2 H)mentioning

confidence: 92%

Intracerebral Hemorrhage Specific Intensity of Care Quality Metrics

Qureshi

2010

Neurocrit Care

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The next step in development of a new ICH specific intensity of care quality metrics is validation and refinement of the quality indicators and thresholds presented in the current report. Future activities may include selection and validation based on consensus of experts and application of the system to a large series of patients with ICH and assessment of relationship of components in isolation and as a group to outcome after severity adjustment.

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“…Rapid reversal of international normalised ratios also enables urgent surgical evacuations in patients who are deteriorating neurologically with intracerebral haemorrhage related to oral anticoagulant use. One study 145 reported a high rate (65%) of favourable outcomes in patients with prominent midline shift (with or without uncal herniation) who had emergent surgical evacuation after reversal.…”

Section: Intracerebral Haemorrhage Related To Use Of Oral Anticoagulantsmentioning

confidence: 99%

Intracerebral haemorrhage

2009

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Intracerebral haemorrhage is an important public health problem leading to high rates of death and disability in adults. Although the number of hospital admissions for intracerebral haemorrhage has increased worldwide in the past 10 years, mortality has not fallen. Results of clinical trials and observational studies suggest that coordinated primary and specialty care is associated with lower mortality than is typical community practice. Development of treatment goals for critical care, and new sequences of care and specialty practice can improve outcome after intracerebral haemorrhage. Specific treatment approaches include early diagnosis and haemostasis, aggressive management of blood pressure, open surgical and minimally invasive surgical techniques to remove clot, techniques to remove intraventricular blood, and management of intracranial pressure. These approaches improve clinical management of patients with intracerebral haemorrhage and promise to reduce mortality and increase functional survival.

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Determinants of Outcome in Anticoagulation-Associated Cerebral Hematoma Requiring Emergency Evacuation

Abstract: To analyze the likelihood of recovery and prognostic factors in patients with massive anticoagulation-associated intracerebral hemorrhage treated with surgical evacuation after reversal of anticoagulation.

Cited by 17 publications

References 9 publications

Malignant Profile Detected by CT Angiographic Information Predicts Poor Prognosis despite Thrombolysis within Three Hours from Symptom Onset

Malignant Profile Detected by CT Angiographic Information Predicts Poor Prognosis despite Thrombolysis within Three Hours from Symptom Onset

Intracerebral Hemorrhage Specific Intensity of Care Quality Metrics

Intracerebral haemorrhage

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