BACKGROUND: Warfarin use increases mortality in patients with intracerebral hemorrhage (ICH). Larger hematoma volume and infratentorial location are both major determinants of poor outcome in ICH. Although warfarin-associated intracerebral hemorrhages have greater volumes, there is uncertainty about the effects of location. We aimed to investigate the influence of warfarin on hematoma volume and location. METHODS: We conducted a retrospective study of all patients hospitalized for ICH at a large stroke center from October 2007 to January 2012. Initial CT scans were used to quantify hematoma volumes using the computer-assisted planimetric analysis. Univariate and multivariable analyses determined the influence of warfarin on hemorrhage location. Median regression analysis was performed to estimate the effects of INR on hematoma volumes. RESULTS: We included 404 consecutive patients with ICH of whom 69 were on warfarin. Patients on warfarin had larger hematoma volumes (median 23.9mL vs. 14.2mL; P=0.046). In patients excessively anticoagulated with warfarin (defined as INR>3.0), compared with those in the therapeutic range, brainstem ICH was more frequent (24.0% vs. 6.1%; P=0.005). Patients with INR>3.0 had increased odds of infratentorial hemorrhage (OR 3.63; 95% CI 1.52-8.64; P=0.004) when compared to non-warfarin ICH patients. After adjustment for hematoma location, there was no significant association between INR and hematoma volume. CONCLUSIONS: Patients with warfarin-associated ICH have a predilection for brainstem ICH. After adjustment for ICH location, no relationship between admission INR and hematoma volume was found.
BACKGROUND:Warfarin use increases mortality in patients with intracerebral hemorrhage (ICH). Larger hematoma volume and infratentorial location are both major determinants of poor outcome in ICH. Although warfarin-associated intracerebral hemorrhages have greater volumes, there is uncertainty about the effects of location. We aimed to investigate the influence of warfarin on hematoma volume and location. METHODS: We conducted a retrospective study of all patients hospitalized for ICH at a large stroke center from October 2007 to January 2012. Initial CT scans were used to quantify hematoma volumes using the computer-assisted planimetric analysis. Univariate and multivariable analyses determined the influence of warfarin on hemorrhage location. Median regression analysis was performed to estimate the effects of INR on hematoma volumes. RESULTS: We included 404 consecutive patients with ICH of whom 69 were on warfarin. Patients on warfarin had larger hematoma volumes (median 23.9mL vs. 14.2mL; P=0.046). In patients excessively anticoagulated with warfarin (defined as INR>3.0), compared with those in the therapeutic range, brainstem ICH was more frequent (24.0% vs. 6.1%; P=0.005). Patients with INR>3.0 had increased odds of infratentorial hemorrhage (OR 3.63; 95% CI 1.52-8.64; P=0.004) when compared to non-warfarinICHpatients. After adjustment for hematoma location, there was no significant association between INR and hematoma volume. CONCLUSIONS:Patients with warfarin-associated ICH have a predilection for brainstem ICH. After adjustment for ICH location, no relationship between admission INR and hematoma volume was found.
Authors: Gustavo Zapata-Wainberg; Álvaro Ximénez-Carrillo Rico; Lorena Benavente Fernández; Jaime Masjuan Vallejo; Jaime Gállego Culleré; María Del Mar Freijó Guerrero; José Egido; José Carlos Gómez Sánchez; Alejandro Martínez Domeño; Francisco Purroy García; Bárbara Vives Pastor; Miguel Blanco González; José Vivancos Journal: Interv Neurol Date: 2015-09-18
Authors: Teddy Y Wu; Bruce Cv Campbell; Daniel Strbian; Nawaf Yassi; Jukka Putaala; Turgut Tatlisumak; Stephen M Davis; Atte Meretoja Journal: Eur Stroke J Date: 2016-08-26
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: Fan Zhang; Yanming Ren; Yan Shi; Wei Fu; Chuanyuan Tao; Xi Li; Mu Yang; Chao You; Tao Xin Journal: Medicine (Baltimore) Date: 2019-06 Impact factor: 1.817
Authors: David J Seiffge; Martina B Goeldlin; Turgut Tatlisumak; Philippe Lyrer; Urs Fischer; Stefan T Engelter; David J Werring Journal: J Neurol Date: 2019-09-20 Impact factor: 4.849