Predisposing factors for enlargement of intracerebral hemorrhage in patients treated with warfarin

Masahiro Yasaka; Kazuo Minematsu; Hiroaki Naritomi; Toshiyuki Sakata; Takenori Yamaguchi

doi:10.1055/s-0037-1613443

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2003; 89(02): 278-283
DOI: 10.1055/s-0037-1613443

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Predisposing factors for enlargement of intracerebral hemorrhage in patients treated with warfarin

Masahiro Yasaka

,

Kazuo Minematsu

¹Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan

,

Hiroaki Naritomi

¹Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan

,

Toshiyuki Sakata

¹Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan

,

Takenori Yamaguchi

¹Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan

› Institutsangaben

Abstract

Summary

To elucidate predisposing factors for enlargement of intra-cerebral hematoma (ICH) during warfarin therapy, we reviewed 47 patients on warfarin who developed acute ICH and determined relationships among ICH enlargement, INR reversal and clinical data. Among 36 patients treated to counteract the effects of warfarin within 24 h of onset, ICH increased in 10 patients (enlarged group), but remained unchanged in the remaining 26 (unchanged group), while ICH remained unchanged in another 11 patients in whom the effect of warfarin was reversed after 24 h. The international normalized ratio (INR) was counteracted immediately in 11 patients treated with prothrombin complex concentrate (PCC) but gradually in the other 36 treated by reducing the dose of warfarin, or by administering vitamin K or fresh frozen plasma. Multivariate analysis with a logistic regression model showed an INR value <2.0 at admission or for 24 h after immediate INR correction with PCC prevented ICH enlargement (OR 0.069, 95%CI 0.006-0.789, p = 0.031). An INR value of >2.0 within 24 h of ICH seems an important predisposing factor for ICH enlargement.

Keywords

Intracerebral hematoma - warfarin - prothrombin complex concentrate - international normalized ratio

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Referenzen

References
1 Winzen AR, de Jonge H, Loeliger EA, Bots GTAM. The risk of intracerebral hemorrhage during oral anticoagulant treatment: A population study. Ann Neurol 1984; 16: 553-8.
2 Kase CS, Robinson RK, Stein RW, De Witt LD, Hier DB, Harp DL, Williams JP, Caplan LR, Mohr JP. Anticoagulant-related intracerebral hemorrhage. Neurology 1985; 35: 943-8.
3 Franke CL, de Jonge J, van Swieten JC, Op de Coul AAW, van Gijn J. Intracerebral hematomas during anticoagulant treatment. Stroke 1990; 21: 726-30.
4 Staaf G, Norrving B, Nilsson B. Intracerebral hematomas during anticoagulant treatment. Acta Neurol Scand 1987; 76: 391
5 Hylek EM, Singer DE. Risk factors for intracranial haemorrhage in outpatients taking warfarin. Ann Intern Med 1994; 120: 897-902.
6 Yamaguchi T. for Japanese NVAF-Embolism Secondary Prevention Cooperative Study Group. Optimal intensity of warfarin therapy for secondary prevention of stroke in patients with nonvalvular atrial fibrillation. A multicenter prospective randomized trial. Stroke 2000; 31: 817-21.
7 Kazui S, Minematsu K, Yamamoto H, Sawada T, Yamaguchi T. Predisposing factors to enlargement of spontaneous intracerebral hematoma. Stroke 1997; 28: 2370-5.
8 Boulis NB, Bobek MP, Schmaier A, Hoff JT. Use of factor IX complex in warfarin-related intracranial hemorrhage. Neurosurgery 1999; 45: 1113-9.
9 Cartmill M, Dolan G, Byrne JL, Byrne PO. Prothrombin complex concentrate for oral anticoagulant reversal in neurosurgical emergency. Br J Neurosurg 2000; 14: 458-61.
10 Fredriksson K, Norrving B, Stromblad LG. Emergency reversal of anticoagulation after intracerebral hemorrhage. Stroke 1992; 23: 972-7.
11 Makris M, Graves M, Phillips WS, Kitchen S, Rosendaal FR. Emergency oral anticoagulant reversal: The relative efficacy of infusions of fresh frozen plasma and clotting factor concentrate on correction of the coagulopathy. Thromb Haemost 1997; 77: 477-80.
12 Yasaka M, Sakata T, Minematsu K, Naritomi H, Yamaguchi T. Effect of prothrombin complex concentrate on intracranial hemorrhage in patients with warfarin treatment [abstract]. Stroke 2002; 33: 379
13 Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, Khoury J. The ABCs of measuring intracerebral hemorrhage volume. Stroke 1996; 27: 1304-5.
14 Fujii Y, Tanaka R, Takeuchi S, Koike T, Minakawa T, Sasaki O. Hematoma enlargement in spontaneous intracerebral hemorrhage. J Neurosurg 1994; 80: 51-7.
15 Niizuma H, Shimizu Y, Nakasato N, Jokura H, Suzuki J. Influence of liver dysfunction on volume of putaminal hemorrhage. Stroke 1988; 19: 987-90.
16 Broderick JP, Brott TG, Tomsick T, Barsan W, Spilker J. Ultra-early evaluation of intra-cerebral hemorrhage. J Neurosurg 1990; 72: 195-9.
17 Kelly RE, Berger JR, Scheinberg P, Stokes N. Active bleeding in hypertensive intracerebral hemorrhage: computed tomography. Neurology 1982; 32: 852-6..
18 Chen ST, Chen SD, Hsu CY, Hogan EL. Progression of hypertensive intracerebral hemorrhage. Neurology 1989; 39: 1509-14.