INTRODUCTION: The management of antithrombotic therapy after intracerebral hemorrhage (ICH) in anticoagulated patients is not well defined. We analyzed the risks and benefits of antiplatelet therapy (AG) against the resumption of anticoagulation with vitamin K antagonists (AVK) in a series of patients. MATERIAL AND METHODS: Retrospective study of ICH in anticoagulated patients. We registered demographic data, history of hypertension (HT), time of follow-up and new cerebral vascular events (ICH, stroke [IC]). RESULTS: We evaluated 88 patients, mean age 69±9 years, 50% men, 73% hypertensive. During the acute phase 18 patients died and the follow-up was lost in 31. Of the remaining (n=39), AVKs were resumed in 25 and changed to AG in 14. Comparing the characteristics of both groups, the anticoagulated group was younger (P=.005) and the embolic sources were more often of higher risk (P=.003). After an average follow-up of 54±31 months, the distribution of events was: IC (AVKs 8%, AG 14.3%, P=.6), ICH (AVKs 24%, AG 7.1%, P=.38), IC or ICH (AVKs 32%, AG 21.4%, P=.48) and death (AVKs 29%, AG 7.1%, P=.21). This trend of increased risk of new events in patients with AVKs was confirmed by Kaplan-Meier curves, although without statistical differences. CONCLUSIONS: Restarting AVK treatment after ICH in anticoagulated patients could increase the risk of new bleeding events and mortality. Prospective studies are needed to define a better and appropriate antithrombotic therapy after ICH related with anticoagulation.
INTRODUCTION: The management of antithrombotic therapy after intracerebral hemorrhage (ICH) in anticoagulated patients is not well defined. We analyzed the risks and benefits of antiplatelet therapy (AG) against the resumption of anticoagulation with vitamin K antagonists (AVK) in a series of patients. MATERIAL AND METHODS: Retrospective study of ICH in anticoagulated patients. We registered demographic data, history of hypertension (HT), time of follow-up and new cerebral vascular events (ICH, stroke [IC]). RESULTS: We evaluated 88 patients, mean age 69±9 years, 50% men, 73% hypertensive. During the acute phase 18 patients died and the follow-up was lost in 31. Of the remaining (n=39), AVKs were resumed in 25 and changed to AG in 14. Comparing the characteristics of both groups, the anticoagulated group was younger (P=.005) and the embolic sources were more often of higher risk (P=.003). After an average follow-up of 54±31 months, the distribution of events was: IC (AVKs 8%, AG 14.3%, P=.6), ICH (AVKs 24%, AG 7.1%, P=.38), IC or ICH (AVKs 32%, AG 21.4%, P=.48) and death (AVKs 29%, AG 7.1%, P=.21). This trend of increased risk of new events in patients with AVKs was confirmed by Kaplan-Meier curves, although without statistical differences. CONCLUSIONS: Restarting AVK treatment after ICH in anticoagulated patients could increase the risk of new bleeding events and mortality. Prospective studies are needed to define a better and appropriate antithrombotic therapy after ICH related with anticoagulation.
Authors: Eleni Korompoki; Filippos T Filippidis; Peter B Nielsen; Angela Del Giudice; Gregory Y H Lip; Joji B Kuramatsu; Hagen B Huttner; Jiming Fang; Sam Schulman; Joan Martí-Fàbregas; Celine S Gathier; Anand Viswanathan; Alessandro Biffi; Daniela Poli; Christian Weimar; Uwe Malzahn; Peter Heuschmann; Roland Veltkamp Journal: Neurology Date: 2017-07-19 Impact factor: 9.910
Authors: Peter Brønnum Nielsen; Line Melgaard; Thure Filskov Overvad; Martin Jensen; Torben Bjerregaard Larsen; Gregory Y H Lip Journal: Stroke Date: 2022-04-13 Impact factor: 10.170
Authors: Zien Zhou; Jie Yu; Cheryl Carcel; Candice Delcourt; Jiehui Shan; Richard I Lindley; Bruce Neal; Craig S Anderson; Maree L Hackett Journal: BMJ Open Date: 2018-05-14 Impact factor: 2.692