Safety of Discontinuation of Anticoagulation in Patients With Intracranial Hemorrhage at High Thromboembolic Risk

Phan, Thanh G.; Koh, Merian; Wijdicks, Eelco F. M.

doi:10.1001/archneur.57.12.1710

Cited by 176 publications

(92 citation statements)

References 13 publications

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“…Resumption occurred after a median of 4.4 weeks (IQR 2. [3][4][5][6][7][8][9][10][11][12][13][14] in patients with intracerebral hemorrhage, compared with 6.4 weeks (IQR 3.6 -26) after subdural hematoma.…”

Section: Resumption Of Warfarinmentioning

confidence: 99%

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Optimal Timing of Resumption of Warfarin After Intracranial Hemorrhage

Majeed

Kim

Roberts

et al. 2010

Stroke

186

152

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Background and Purpose-The optimum timing of resumption of anticoagulation after warfarin-related intracranial hemorrhage in patients with indication for continued anticoagulation is uncertain. We performed a large retrospective cohort study to obtain more precise risk estimates. Methods-We reviewed charts of 2869 consecutive patients with objectively verified intracranial hemorrhage over 6 years at 3 tertiary centers. We calculated the daily risk of intracranial hemorrhage or ischemic stroke with and without resumption of warfarin; we focused on patients who survived the first week and had cardiac indication for anticoagulation or previous stroke. Using a Cox model, we estimated rates for these 2 adverse events in relation to different time points of resumed anticoagulation. The combined risk of either a new intracranial hemorrhage or an ischemic stroke was calculated for a range of warfarin resumption times. Results-We identified warfarin-associated intracranial hemorrhage in 234 patients (8.2%), of whom 177 patients (76%) survived the first week and had follow-up information available; the median follow-up time was 69 weeks (interquartile range [IQR] 19 -144). Fifty-nine patients resumed warfarin after a median of 5.6 weeks (IQR 2.6 -17). The hazard ratio for recurrent intracranial hemorrhage with resumption of warfarin was 5.6 (95% CI, 1.8 -17.2), and for ischemic stroke it was 0.11 (95% CI, 0.014 -0.89). The combined risk of recurrent intracranial hemorrhage or ischemic stroke reached a nadir if warfarin was resumed after approximately 10 to 30 weeks. Conclusion-The optimal timing for resumption of warfarin therapy appears to be between 10 and 30 weeks after warfarin-related intracranial hemorrhage. (Stroke. 2010;41:2860-2866.)

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Section: Resumption Of Warfarinmentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12] These studies generally included few patients who were followed at a single center and had limited follow-up. Several of the authors and the American Stroke Association 13 suggest restarting anticoagulation after a period of 7 to 14 days following intracranial hemorrhage.…”

mentioning

confidence: 99%

Optimal Timing of Resumption of Warfarin After Intracranial Hemorrhage

Majeed

Kim

Roberts

et al. 2010

Stroke

186

152

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“…Life-threatening bleeding complications may occur due to the narrow therapeutic range of warfarin (Phan et al, 2000;Libby and Garcia, 2002). The most serious bleeding complication is intracranial bleeding, with mortality rate of up to 50% in 30 days.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological features of warfarin overdose and efficacy of prothrombin complex concentrates

Erdoğan¹,

Ayhan²,

Çolak³

et al. 2014

jecm

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IntroductionDrug overdose-related symptoms are an important part of emergency department (ED) admissions. Drug overdoserelated side effects are more common than suicidal drug intoxications. Drug overdosing is generally related to narrow therapeutic index of the relevant drug. A recent study revealed that drug side effect-related ED admissions comprised 3.6% of admissions in the elderly; 33.3% of these admissions were due to warfarin, digoxin and insulin (Budnitz et al., 2007). A previous study also revealed that 65.7% of all drug intoxications that resulted in to ED admissions were drug overdoses. The most common drugs were warfarin, insulin, antiplatelet and oral hypoglycemic agents (Budnitz et al., 2007).Warfarin is the main vitamin K antagonist (VKA) used as oral anticoagulant, warfarin overdose is the most common cause of drug overdose admissions to ED, (Budnitz et al., 2011). Acenocumarol, phenprocoumon, fluindione and tecarfarin are other vitamin K antagonist derivates of coumarins (Ellis et al., 2009;Altunbaş et al., 2013). Following oral intake, warfarin is absorbed from the gastrointestinal system and binds to plasma albumin. Warfarin acts as an anticoagulant via inhibition of vitamin K-dependent monitoring to estimate the international normalized ratio

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“…Complications from severe bleeding generally outweigh the risk of valve thrombosis. Anticoagulation can be safely interrupted for 7-14 days even in those at high risk for thromboembolic events 41 .…”

Section: Anticoagulation For Cardiac Devices Artificial Valvesmentioning

confidence: 99%