BACKGROUND: Warfarin-associated intracerebral haemorrhage carries poor outcome due to rapid haemorrhage growth. Reversal of warfarin anticoagulation with prothrombin complex concentrate has been implemented as an acute treatment option for these subjects. AIM: We investigated whether survival of subjects with warfarin-associated intracerebral haemorrhage had improved after implementation of reversal of warfarin anticoagulation with prothrombin complex concentrate. METHODS: We identified all subjects with warfarin-associated intracerebral haemorrhage during 1993-2008 among the population of Northern Ostrobothnia, Finland. From 2004 onwards, prothrombin complex concentrate was used in Oulu University Hospital, the only hospital treating intracerebral haemorrhage subjects in the region, to counteract the effect of warfarin in subjects with warfarin-associated intracerebral haemorrhage. We compared the outcomes of subjects admitted during 1993-2003 and 2004-2008 and those treated and not treated with prothrombin complex concentrate. We also explored the predictors for one-year survival of the warfarin-associated intracerebral haemorrhage subjects. RESULTS: We identified altogether 181 subjects who had intracerebral haemorrhage while on warfarin. One-year survival was significantly (P = 0·031) higher for the 60 subjects admitted during 2004-2008 (43·3%) than for the 121 admitted before 2004 (30·6%). In multivariable analysis, prothrombin complex concentrate treatment reduced one-year case fatality (hazard ratio 0·52, 95% confidence interval 0·29-0·93). Thromboembolic complications did not occur more frequently among those treated with prothrombin complex concentrate. CONCLUSION: The survival of warfarin-associated intracerebral haemorrhage subjects among the population of Northern Ostrobothnia has improved likely because of introduction of prothrombin complex concentrate.
BACKGROUND:Warfarin-associated intracerebral haemorrhage carries poor outcome due to rapid haemorrhage growth. Reversal of warfarin anticoagulation with prothrombin complex concentrate has been implemented as an acute treatment option for these subjects. AIM: We investigated whether survival of subjects with warfarin-associated intracerebral haemorrhage had improved after implementation of reversal of warfarin anticoagulation with prothrombin complex concentrate. METHODS: We identified all subjects with warfarin-associated intracerebral haemorrhage during 1993-2008 among the population of Northern Ostrobothnia, Finland. From 2004 onwards, prothrombin complex concentrate was used in Oulu University Hospital, the only hospital treating intracerebral haemorrhage subjects in the region, to counteract the effect of warfarin in subjects with warfarin-associated intracerebral haemorrhage. We compared the outcomes of subjects admitted during 1993-2003 and 2004-2008 and those treated and not treated with prothrombin complex concentrate. We also explored the predictors for one-year survival of the warfarin-associated intracerebral haemorrhage subjects. RESULTS: We identified altogether 181 subjects who had intracerebral haemorrhage while on warfarin. One-year survival was significantly (P = 0·031) higher for the 60 subjects admitted during 2004-2008 (43·3%) than for the 121 admitted before 2004 (30·6%). In multivariable analysis, prothrombin complex concentrate treatment reduced one-year case fatality (hazard ratio 0·52, 95% confidence interval 0·29-0·93). Thromboembolic complications did not occur more frequently among those treated with prothrombin complex concentrate. CONCLUSION: The survival of warfarin-associated intracerebral haemorrhage subjects among the population of Northern Ostrobothnia has improved likely because of introduction of prothrombin complex concentrate.
Authors: Vincent Degos; Erick M Westbroek; Michael T Lawton; J Claude Hemphill; Gregory J Del Zoppo; William L Young Journal: Anesthesiology Date: 2013-07 Impact factor: 7.892
Authors: Adrian R Parry-Jones; Mario Di Napoli; Joshua N Goldstein; Floris H B M Schreuder; Sami Tetri; Turgut Tatlisumak; Bernard Yan; Koen M van Nieuwenhuizen; Nelly Dequatre-Ponchelle; Matthew Lee-Archer; Solveig Horstmann; Duncan Wilson; Fulvio Pomero; Luca Masotti; Christine Lerpiniere; Daniel Agustin Godoy; Abigail S Cohen; Rik Houben; Rustam Al-Shahi Salman; Paolo Pennati; Luigi Fenoglio; David Werring; Roland Veltkamp; Edith Wood; Helen M Dewey; Charlotte Cordonnier; Catharina J M Klijn; Fabrizio Meligeni; Stephen M Davis; Juha Huhtakangas; Julie Staals; Jonathan Rosand; Atte Meretoja Journal: Ann Neurol Date: 2015-05-14 Impact factor: 10.422
Authors: Marjolein P A Brekelmans; Kim van Ginkel; Joost G Daams; Barbara A Hutten; Saskia Middeldorp; Michiel Coppens Journal: J Thromb Thrombolysis Date: 2017-07 Impact factor: 2.300