The Effect of Warfarin and Intensity of Anticoagulation on Outcome of Intracerebral Hemorrhage

Rosand, Jonathan; Eckman, Mark H.; Knudsen, Katherine; Singer, Daniel E.; Greenberg, Steven M.

doi:10.1001/archinte.164.8.880

Cited by 580 publications

(464 citation statements)

References 42 publications

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“…19 Furthermore, a history of cerebrovascular disease is an independent predictor of intracerebral hematoma (odds ratio, 3.1; 95% CI, 1.7-5.6) among outpatients taking warfarin, 19 underscoring the potential mechanisms by which previous stroke might increase the risk of intracerebral hemorrhage including (1) underlying small cerebral vessel disease such as cerebral amyloid angiopathy 20 or (2) the presence of the subclinical (silent) or occult brain infarcts that may predispose to brain hemorrhage. 21 When warfarin-related intracerebral hemorrhage occurs, stroke mortality rate doubles in a dose-dependent manner, 22 likely related to the large size of hematoma. 23 Thus, preventing hemorrhagic cerebrovascular events is of paramount importance for those patients who require anticoagulation because of high risk of recurrent embolic stroke.…”

Section: Discussionmentioning

confidence: 99%

Outcomes With Edoxaban Versus Warfarin in Patients With Previous Cerebrovascular Events

Rost

Giugliano

Ruff

et al. 2016

Stroke

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T he risk of stroke in patients with atrial fibrillation (AF) is high, 1 and it increases in the presence of other risk factors such as advanced age, congestive heart failure, hypertension, diabetes mellitus, and especially previous ischemic stroke (IS) or transient ischemic attack (TIA). 2 However, even validated risk-stratification scores using these and additional risk factors, such as CHADS 2 (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke) and CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75: 2, diabetes, stroke: 2, vascular disease, sex female) scores 2,3 may underestimate the true risk of stroke recurrence in patients with a previous IS or TIA, 4,5 which might reach as high as 7% to 10% per year. 4,6 Therefore, secondary prevention of stroke in these higher risk patients with AF is a major focus of cerebrovascular care. Background and Purpose-Patients

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Section: Discussionmentioning

confidence: 99%

Outcomes With Edoxaban Versus Warfarin in Patients With Previous Cerebrovascular Events

Rost

Giugliano

Ruff

et al. 2016

Stroke

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“…Whenever the model required data that could not be retrieved from the Hokusai-VTE trial, transition probabilities were derived from publications; these data included the probability of developing CTEPH [10] and PTS [11] after a VTE event, the probability of disability following ICH [12], some disease-specific mortality rates (due to a PE recurrence [13], the probability of dying when disabled from ICH [14], and short-term [15] and long-term mortality [16] from CTEPH), and the probability of developing rVTE while off treatment [17] (Table 2). The general mortality of the cohort depended on the gender distribution and mean age across the time horizon.…”

Section: Methodsmentioning

confidence: 99%

“…The long-term impact of ICH resulting in disability was categorised as mild, moderate, and severe for both the care centre costs and home care costs. On average, the monthly costs for a disabled patient with ICH were estimated to be £524 [12,29]. It was assumed that there were no costs associated with death and the off treatment health state.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of edoxaban compared to warfarin for the treatment and secondary prevention of venous thromboembolism in the UK

Clay

Jamotte

Verhamme

et al. 2018

Journal of Market Access & Health Policy

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Background: Venous thromboembolism (VTE), which includes pulmonary embolism (PE) and deep vein thrombosis (DVT), is the third most common acute cardiovascular disease and represents an important burden for patients and payers.Objective: The aim was to estimate the cost-effectiveness of edoxaban, a non-VKA oral anticoagulant vs. warfarin, the currently most prescribed treatment for VTE in the UK.Study design: A Markov model was built using data from the Hokusai-VTE randomised controlled trial to estimate the lifetime costs and quality-adjusted life years (QALYs) in patients with VTE treated with edoxaban or warfarin over a lifetime horizon, from the UK National Health Services perspective. The model included VTE recurrences, VTE-related complications (post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension), and several types of bleeds associated with anticoagulation treatment. Patients were treated during a period of 6 months after the first VTE event, followed by flexible treatment duration (from 6 months to lifetime) after recurrence, i.e., tertiary prevention.Results: Edoxaban was found dominant vs. warfarin with 0.033 additional QALY and £55 less costs. The reduction of patient management costs, specifically monitoring costs, outweighed the higher drug costs. Edoxaban was dominant in all subgroups (index DVT only, all PE cases (PE with or without DVT), PE without DVT and PE with DVT). Cost-savings ranged from £54 to £81 while additional QALYs ranged from 0.031 to 0.046. Edoxaban was found dominant in 88.6% of cases and cost-effective in additional 10.9% of cases considering a £20,000 threshold in the probabilistic sensitivity analysis.Conclusion: Edoxaban may improve patients’ quality of life in a lifetime horizon without additional costs for the healthcare system due to lower bleeding risk and no monitoring cost compared to warfarin.

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“…The observed increase is most likely due to the increased use of warfarin by patients with atrial fibrillation [58]. The use of warfarin at the time of ICH is associated with hematoma expansion [16,18] and increased mortality [15][16][17]59].…”

Section: Anticoagulation Reversalmentioning

confidence: 99%

Therapeutic Strategies in Acute Intracerebral Hemorrhage

Brouwers

Goldstein

2012

Neurotherapeutics

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The Effect of Warfarin and Intensity of Anticoagulation on Outcome of Intracerebral Hemorrhage

Abstract: Patients taking warfarin had a doubling in the rate of intracerebral hemorrhage mortality in a dose-dependent manner. The data suggest that careful control of the INR, already known to limit the risk of warfarin-related ICH, may also limit its severity.

Cited by 580 publications

References 42 publications

Outcomes With Edoxaban Versus Warfarin in Patients With Previous Cerebrovascular Events

Outcomes With Edoxaban Versus Warfarin in Patients With Previous Cerebrovascular Events

Cost-effectiveness of edoxaban compared to warfarin for the treatment and secondary prevention of venous thromboembolism in the UK

Therapeutic Strategies in Acute Intracerebral Hemorrhage

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