Intracranial Hemorrhage and Oral Anticoagulant Treatment

Abstract

Objective: To detect risk factors for intracranial hemorrhage (ICH) in patients with long-term oral anticoagulant and to identify clinical or radiological data specific of anticoagulant-related ICH. Methods and Patients: Three groups of patients were included. Group 1 represents patients who were admitted because of anticoagulant-related ICH between January 1984 and February 1996. All patients underwent CT scan. Clinical data, anticoagulation parameters, location and volume of the ICH, treatment and the 30-days in-hospital mortality were analyzed. Group 2 consisted of patients selected at random among all patients with spontaneous ICH admitted to our department during the same period of time. Patients without ICH, but regularly taking oral anticoagulants constituted group 3. Results: Seventy-nine patients with anticoagulant-related ICH were compared to 127 patients with spontaneous ICH. The volume of supratentorial ICH was greater in group 1 of patients and was correlated with a worse prognosis. Comparison of group 1 with group 3 (212 controls) demonstrated that length of anticoagulation, prothrombin time or excessive anticoagulation, prior cerebral infarct and use of acénocoumarol, but not age or indication of anticoagulant, were significant risk factors for ICH in multivariate analysis. Conclusions: The results emphasize that anticoagulant-related ICH are not clinically different from spontaneous ICH except for volume of bleeding, and that frequent and careful coagulation monitoring is needed, especially during the first year in order to decrease the risk of ICH.

Warfarin‐related intracerebral haemorrhage: better outcomes when reversal includes prothrombin complex concentrates

“…In the 15 of these patients who also received PCC, the dose of FFP was 1-2 units, as specified by the protocol (when given with PCC). However, in the remaining patients (FFP and vitamin K alone), doses of FFP were also small (median 2 units, range [1][2][3][4][5][6].…”

Management and Prognostic Features of Intracerebral Hemorrhage During Anticoagulant Therapy: A Swedish Multicenter Study

“…A statistical analysis of aggregated data from previous studies shows that mortality in AC-related ICH is, on average, 14% units higher (range 10% to 32% units) than in spontaneous ICH [3][4][5]8 (PϽ0.01). Although it was not the main aim of the present study, we could verify this observation in a subset of our patients because a comparison could be made with a previously published patient material of spontaneous ICH from 1 hospital.…”

“…Compared with spontaneously occurring ICHs, AC-related ICHs are often larger and carry a higher mortality (44% to 68% at 1 to 6 months). [3][4][5][6][7][8] Low prothrombin complex values, ie, high international normalized ratios (INRs), increase the risk of ICH, 8,9 but the relationship between the INR value on admission and the prognosis has not been extensively studied. 3,10 Major textbooks published in the early 1990s and a recently published authorized guideline provide either no specific recommendations of pharmacological treatment of AC-related ICH in the acute phase, 11,12 or they recommend the use of vitamin K or plasma.…”

Update in Intracerebral Hemorrhage

“…15 Nevertheless, most warfarin-associated ICH cases occur during times when warfarin is in the therapeutic range (international normalized ratio [INR] 2.0-3.0). 16,17 Dabigatran, an oral direct thrombin inhibitor, has recently been approved by the Food and Drug Administration ( [FDA] October 2010) 18 for the prevention of stroke and blood clots in patients with abnormal heart rhythm (atrial fibrillation). In a randomized trial (dabigatran vs warfarin in patients with atrial fibrillation, RELY), [19][20][21] it was found that dabigatran was not inferior to adjusted dose warfarin for the prevention of cardioembolic stroke in the setting of atrial fibrillation, and it had less major bleeding complications than warfarin.…”