This article is more than 5 years old. Information may no longer be current.
Researchers identify approaches to manage anticoagulant-related intracerebral hemorrhage
Click Here to Manage Email Alerts
Attainment of two clearly defined clinical thresholds — one related to international normalized ratio reversal and the other related to systolic blood pressure — appear associated with reduced rates of hematoma enlargement in patients with oral anticoagulant-related intracerebral hemorrhage, according to study results.
Resumption of anticoagulant therapy was associated with a lower risk for ischemic events, results also showed.
Joji B. Kuramatsu, MD, of the department of neurology at the University of Erlangen-Nuremberg in Germany, and colleagues evaluated data from 1,176 patients (mean age, 74.1 years) with oral anticoagulant-associated intracerebral hemorrhage.
The patients had a median baseline intracerebral hemorrhage volume of 19.3 cm3 (interquartile range [IQR], 6.9-52.8) and a median international normalized ratio (INR) — the measure used to determine the blood clotting tendency while on medication — of 2.77 (IQR, 2.28-3.5) at the time of hospitalization.
Data on hematoma enlargement were available from 853 of the patients. Of these patients, 307 (36%) experienced hematoma enlargement; median volume increase was 14 cm3 (IQR, 4.7-36.8).
Reversal of INR levels to less than 1.3 within 4 hours was associated with fewer rates of hematoma enlargement compared with INR levels of 1.3 or greater (19.8% vs. 41.5%; P ˂ .001). Systolic blood pressure less than 160 mm Hg at 4 hours was associated with reduced rates of hematoma enlargement (33.1% vs. 52.4%; P ˂ .001) compared with systolic blood pressure of 160 mm Hg or greater.
Attainment of both the INR and systolic blood pressure thresholds was associated with a significantly reduced risk for hematoma enlargement (OR = 0.28; 95% CI, 0.19-0.42) and in-hospital mortality (OR = 0.6; 95% CI, 0.37-0.95).
Data on oral anticoagulant resumption were available from 719 surviving patients, 172 of whom resumed therapy (23.9%). Patients who resumed anticoagulation were significantly less likely to experience an ischemic event (5.2% vs. 15%; P ˂ .001). The occurrence of hemorrhagic complications was comparable among patients who did and did not resume oral anticoagulation (8.1% vs. 6.6%).
Results of a propensity-matched survival analysis indicated patients with atrial fibrillation who recommenced oral anticoagulation were at a reduced risk for long-term mortality (HR = 0.25; 95% CI, 0.12-0.53).
A majority of patients (72.6%) experienced unfavorable long-term functional outcome. Unfavorable functional outcomes were associated with ischemic stroke (RR = 1.43; 95% CI, 1.05-1.94) and hemorrhagic stroke (RR = 2.58; 95% CI, 1.7-3.9); however, resumption of oral anticoagulation was associated with a decreased risk for unfavorable outcome by 1 year (RR = 0.55; 95% CI, 0.39-0.77).
“Among patients with oral anticoagulant-associated intracerebral hemorrhage, reversal of INR below 1.3 within 4 hours and systolic blood pressure less than 160 mm Hg at 4 hours were associated with lower rates of hematoma enlargement, and resumption of anticoagulation therapy was associated with lower risk of ischemic events without increased bleeding complications,” Kuramatsu and colleagues concluded. “These retrospective findings require replication and assessment in prospective studies.” – by Alexandra Todak
Disclosure: Kuramatsu reports travel grants and honoraria from Boehringer Ingelheim, EMCools and Otsuka. The other researchers report financial relationships with AstraZeneca, Bayer, Bristol-Myers Squibb, Daiichi Sankyo, Pfizer, Roche and other pharmaceutical companies.
Click Here to Manage Email Alerts