Antithrombotic Therapy and Predilection for Cerebellar Hemorrhage

Abstract

Background: With the recent increase in the use of antithrombotic therapy, intracerebral hemorrhage (ICH) has been found to be a common complication. We determined whether the use of oral antithrombotic therapy and the patients’ preexisting comorbidities were predictive of cerebellar hemorrhage (CH; previously reported to be associated with anticoagulants) as compared to other ICH, and whether antithrombotic therapy affected the clinical severity of CH. Methods: A study of 327 consecutive patients hospitalized in our institute within 3 days after the onset of ICH, including 38 patients with a CH. Results: CH accounted for 12% of all ICH, 75% of which occurred in patients on warfarin therapy with an international normalized ratio (INR) for prothrombin time >2.5 (p < 0.0001), and 33% of which occurred in patients on ticlopidine therapy (p = 0.017). Warfarin therapy with an INR >2.5 and high blood glucose on admission were independently predictive of CH as compared to other ICH. In addition, previous ischemic stroke (p = 0.002) and heart diseases (p = 0.018) were more prevalent in patients with CH than in those with other ICH. The number of major arteriosclerotic comorbidities and risk factors was also independently predictive of CH risk. Conclusions: We confirmed that warfarin therapy with an INR >2.5 is associated with CH. Patients with CH frequently had arteriosclerotic comorbidities requiring antithrombotic therapy that can complicate their acute management.

Intracerebral Hemorrhage: Influence of Topography of Bleeding on Clinical Spectrum and Early Outcome

“…The in-hospital mortality of 21.4% observed in our patients [5] is lower than 39-47% observed in other studies [22][23][24] and similar to death rates (13% and 25%) reported by other authors [25,26]. Patients with larger cerebellar hematomas ussually develop brainstem compression [25,28].…”

Antithrombotic Therapy Influences Location, Enlargement, and Mortality from Intracerebral Hemorrhage

“…The present study showed that there was a strong relationship between cerebellar hemorrhage and any type of antithrombotic therapy, including antiplatelet medication. This result is clearer than our previous one [28], partly because the larger population reduced statistical errors. However, the mechanism that explains why antithrombotic therapy triggers cerebellar hemorrhage remains unknown.…”

“…In our previous study involving 327 ICH patients [28], warfarin therapy with an INR >2.5 was associated with an excess of cerebellar hemorrhage. A study from Hong Kong showed that there was a predilection for lobar hemorrhage among aspirin users [29], while other studies did not show this [7, 8].…”

Prior Oral Antithrombotic Therapy is Associated with Early Death in Patients with Supratentorial Intracerebral Hemorrhage

“…The most common location of hematoma was the thalamus in the OA group, and putaminal hemorrhage was less than in non OA group. This phenomenon was similar to previous studies (12,27). In the OA group, thalamus or basal ganglia were the common location of supratentorial hemor- (15).…”

“…Table 2 shows vital signs, CT findings, outcome, and laboratory data. GCS was lower in the OA group than in the non-OA group (median 10 [25th-75th percentile: 5-14] vs., 13 [10][11][12][13][14][15], p<0.001). The OA group had larger hematoma [median 22 mL (25th-75th percentile: 7.2-100 mL), vs. median 14 mL (7-42 mL), p<0.001].…”