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Management and prognostic features of intracerebral hemorrhage during anticoagulant therapy - A Swedisih multicenter study

Sjöblom, Lars; Hardemark, Hans-Göran; Lindgren, Arne LU ; Norrving, Bo LU ; Fahlen, Martin; Samuelsson, Margareta; Stigendal, Lennart; Stockelberg, Dick; Taghavi, Ali and Wallrup, Lena, et al. (2001) In Stroke: a journal of cerebral circulation 32(11). p.2567-2574
Abstract
Background and Purpose-Patients treated with oral anticoagulants (ACs) have an increased risk of intracerebral hemorrhage (ICH), which is more often fatal than spontaneous ICH. Options to reverse the AC effect include intravenous administration of vitamin K, plasma, and coagulation factor concentrate. However, the optimal management of AC-related ICH has not been determined in any randomized trial. In this study, the present management of AC-related ICH was surveyed, and determinants of survival were assessed. Methods-We retrospectively reviewed the medical records of all AC-related ICHs at 10 Swedish hospitals during a 4-year period, 1993 to 1996. Survival status after the ICH was determined from the Swedish National population register.... (More)
Background and Purpose-Patients treated with oral anticoagulants (ACs) have an increased risk of intracerebral hemorrhage (ICH), which is more often fatal than spontaneous ICH. Options to reverse the AC effect include intravenous administration of vitamin K, plasma, and coagulation factor concentrate. However, the optimal management of AC-related ICH has not been determined in any randomized trial. In this study, the present management of AC-related ICH was surveyed, and determinants of survival were assessed. Methods-We retrospectively reviewed the medical records of all AC-related ICHs at 10 Swedish hospitals during a 4-year period, 1993 to 1996. Survival status after the ICH was determined from the Swedish National population register. Results-We identified 151 patients with AC-related ICH. Death rates were 53.6% at 30 days, 63.6% at 6 months, and 77.5% at follow-up (mean 3.5 years). The case fatality ratio at 30 days was 96% among patients unconscious on admission (n=27), 80% among patients who became unconscious before active treatment was started (n=15), 55% among patients in whom no special action was taken except withdrawal of AC treatment (n=42), and 28% among patients given active anti-coumarin treatment while they were still conscious (n=64). The case fatality, ratio at 30 days was 11% in the group treated with plasma (n = 18), 30% in the group treated with vitamin K (n = 23), and 39% in the group treated with coagulation factor concentrate (n=23). Within the first 24 to 48 hours after admission, 47% of the patients deteriorated. Choice of therapy to reverse the AC effect differed substantially between the hospitals (P <0.0001), as did the time interval from symptom onset to start of treatment. Multiple logistic regression analysis showed only 2 factors (intraventricular extension of bleeding and ICH volume) that were independently related to case fatality at both 30 days and 6 months. The results were similar when the analysis was restricted to patients who were conscious on admission. Conclusions-In AC-related ICH, a progressive, neurological deterioration during the first 24 to 48 hours after admission is frequent, and the mortality is high. Choice of therapy to reverse the AC effect differed considerably between the hospitals. There was no evidence that any treatment strategy was superior to the others. A randomized controlled trial is needed to determine the best choice of treatment. (Less)
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publishing date
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Contribution to journal
publication status
published
subject
keywords
prognosis, anticoagulants, cerebral hemorrhage, tomography, x-ray computed
in
Stroke: a journal of cerebral circulation
volume
32
issue
11
pages
2567 - 2574
publisher
American Heart Association
external identifiers
  • wos:000172059800021
  • scopus:0035168884
ISSN
1524-4628
DOI
10.1161/hs1101.098523
language
English
LU publication?
yes
id
82807bb8-6beb-4ce7-b2de-8c891c1480f8 (old id 1118678)
date added to LUP
2008-07-15 08:28:52
date last changed
2018-09-09 04:25:40
@article{82807bb8-6beb-4ce7-b2de-8c891c1480f8,
  abstract     = {Background and Purpose-Patients treated with oral anticoagulants (ACs) have an increased risk of intracerebral hemorrhage (ICH), which is more often fatal than spontaneous ICH. Options to reverse the AC effect include intravenous administration of vitamin K, plasma, and coagulation factor concentrate. However, the optimal management of AC-related ICH has not been determined in any randomized trial. In this study, the present management of AC-related ICH was surveyed, and determinants of survival were assessed. Methods-We retrospectively reviewed the medical records of all AC-related ICHs at 10 Swedish hospitals during a 4-year period, 1993 to 1996. Survival status after the ICH was determined from the Swedish National population register. Results-We identified 151 patients with AC-related ICH. Death rates were 53.6% at 30 days, 63.6% at 6 months, and 77.5% at follow-up (mean 3.5 years). The case fatality ratio at 30 days was 96% among patients unconscious on admission (n=27), 80% among patients who became unconscious before active treatment was started (n=15), 55% among patients in whom no special action was taken except withdrawal of AC treatment (n=42), and 28% among patients given active anti-coumarin treatment while they were still conscious (n=64). The case fatality, ratio at 30 days was 11% in the group treated with plasma (n = 18), 30% in the group treated with vitamin K (n = 23), and 39% in the group treated with coagulation factor concentrate (n=23). Within the first 24 to 48 hours after admission, 47% of the patients deteriorated. Choice of therapy to reverse the AC effect differed substantially between the hospitals (P &lt;0.0001), as did the time interval from symptom onset to start of treatment. Multiple logistic regression analysis showed only 2 factors (intraventricular extension of bleeding and ICH volume) that were independently related to case fatality at both 30 days and 6 months. The results were similar when the analysis was restricted to patients who were conscious on admission. Conclusions-In AC-related ICH, a progressive, neurological deterioration during the first 24 to 48 hours after admission is frequent, and the mortality is high. Choice of therapy to reverse the AC effect differed considerably between the hospitals. There was no evidence that any treatment strategy was superior to the others. A randomized controlled trial is needed to determine the best choice of treatment.},
  author       = {Sjöblom, Lars and Hardemark, Hans-Göran and Lindgren, Arne and Norrving, Bo and Fahlen, Martin and Samuelsson, Margareta and Stigendal, Lennart and Stockelberg, Dick and Taghavi, Ali and Wallrup, Lena and Wallvik, Jonas},
  issn         = {1524-4628},
  keyword      = {prognosis,anticoagulants,cerebral hemorrhage,tomography,x-ray computed},
  language     = {eng},
  number       = {11},
  pages        = {2567--2574},
  publisher    = {American Heart Association},
  series       = { Stroke: a journal of cerebral circulation},
  title        = {Management and prognostic features of intracerebral hemorrhage during anticoagulant therapy - A Swedisih multicenter study},
  url          = {http://dx.doi.org/10.1161/hs1101.098523},
  volume       = {32},
  year         = {2001},
}