Management of intracranial hemorrhage associated with anticoagulant therapy

Kawamata, Takakazu; Takeshita, Mikihiko; Kubo, O; Izawa, Masahiro; Kagawa, Mizuo; Takakura, Kintomo

doi:10.1016/0090-3019(95)00249-9

Cited by 127 publications

(76 citation statements)

References 26 publications

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“…3,4,6) The PT-INR is related to the risk of the major hemorrhagic complications in the whole body. Major hemorrhagic complications often occur in patients with normal values (PT-INR 2.2 to 3.5) and the frequency (6.6% per year) is significantly higher than that in patients with low values (PT-INR 1.5 to 2.1; 0% per year).…”

Section: Discussionmentioning

confidence: 99%

“…4) Patients taking warfarin should receive reversal agents in an attempt to reverse coagulopathy soon after admission. Platelets should also be administered to patients taking antiplatelet agents.…”

Section: Discussionmentioning

confidence: 99%

“…4,6) Patients who develop acute subdural hematoma frequently have different clinical courses and worse outcome than unaffected patients. 3) This study reviewed 90 cases of acute subdural hematoma, including 25 cases with previous medication related to bleeding tendency, and discusses the clinical course, treatment, and outcome.…”

Section: Introductionmentioning

confidence: 99%

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Acute Subdural Hematoma in Patients With Medication Associated With Risk of Hemorrhage

Oyama

Kito

Maki

et al. 2011

Neurol. Med. Chir.(Tokyo)

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The characteristics of 90 cases of acute subdural hematoma were analyzed in 25 patients taking medication related to bleeding tendency, the bleeding tendency group, and 65 patients without such medication, the control group. Acute subdural hematoma was significantly associated with over-turning or without accident in the bleeding tendency group (92%) compared with the control group (56.9%). The time from trauma to admission was significantly longer in the bleeding tendency group (32.7 hours) compared with the control group (9.7 hours). The mean Glasgow Coma Scale score on admission was 13.0 points in the bleeding tendency group and was significantly better than 10.9 points in the control group. The international normalized ratio of prothrombin time on admission was 3.59 in the patients treated with warfarin. All patients taking warfarin received reversal agents and this value decreased significantly to 1.38. In the bleeding tendency group, hematoma size increased in 20% after the operation, almost the same as in the control group (25%). Although good recovery tended to be observed less frequently in the bleeding tendency group than in the control group, the mean age of the bleeding tendency group was significantly higher than that of the control group, so the prognosis might be affected by this age-related factor. Cautious diagnosis, follow-up imaging, and strict management are mandatory in patients with bleeding tendency.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Acute Subdural Hematoma in Patients With Medication Associated With Risk of Hemorrhage

Oyama

Kito

Maki

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…Most of the published cases concern neonates [2] or are associated with ruptured arteriovenous malformations [3], aneurysms [4], or coagulation disorders such as anticoagulation or antiaggregant therapy [1,5,6,7]. Haemophiliac patients [8] and those with idiopathic thrombocytopenic purpura [9] have also developed haematomas in the posterior cranial fossa; thrombocytopenia may result in a hypocoagulable state, increasing the risk of spontaneous intracranial haemorrhage [10].…”

Section: Discussionmentioning

confidence: 99%

“…Coagulation disorders are known to be associated with spontaneous intracranial haematomas [1], but they are rare in the posterior cranial fossa and in the subdural space. CT diagnosis of subdural haematomas may be challenging in the subacute stage.…”

Section: Introductionmentioning

confidence: 99%