Intracerebral hematomas during anticoagulant treatment.

Abstract

We retrospectively studied 79 patients from three centers who suffered an intracerebral hemorrhage during treatment with anticoagulants and compared them with 84 patients from one center who suffered a spontaneous intracerebral hemorrhage without anticoagulant treatment Mortality after 30 days was slightly higher in patients with anticoagulant treatment (67%) than in those without (55%), and the proportion of patients who attained moderate or complete recovery was slightly smaller in the treated group (22% and 36%, respectively); neither difference was statistically significant. Volume of the supratentorial hematoma was measured from computed tomograms in 70% of the patients in both groups and was significantly greater in the 55 patients treated with anticoagulants than in the 59 patients not so treated. Volume was not related to the degree of anticoagulation. Based on the total number of patients treated with anticoagulants in the Heerlen region, we conclude that for patients older than 50 years of age the risk of intracerebral hemorrhage during anticoagulant treatment is increased approximately eightfold but is unrelated to the degree of anticoagulation. Our results suggest that intracerebral hemorrhage is more frequent and more extensive in patients treated with anticoagulants but that once it has occurred in such patients intracerebral hemorrhage is not significantly more serious than in untreated patients. (Stroke 1990;21:726-730) T he occurrence of intracerebral hemorrhage (ICH) in patients treated with anticoagulants is a serious complication, often fatal. The risk of ICH in patients >50 years of age who have been treated with anticoagulants is estimated to be 10 times that in untreated subjects of the same age.1 In that study, outcome in treated patients was not different from that in untreated patients, but ICH was diagnosed mainly on clinical grounds. Additionally, it is uncertain whether the risk of ICH is related to the duration and degree of anticoagulation. According to some studies the risk is greatest during the first 6 months, 2 whereas other workers have found that most ICHs occur after at least 1 year of anticoagulation.1 Though ICH in patients receiving anticoagulants often results from overtreatment, many authors have reported a therapeutic degree of anticoagulation at the moment of the bleeding. Received June 23, 1989; accepted January 9, 1990. has not yet been studied in relation to the use of anticoagulants.The purpose of our retrospective study, which we believe is the largest of its type, was to examine the influence of anticoagulation treatment on the risk of ICH, the volume of the hematoma, and the clinical course compared with patients suffering an ICH who were not treated with anticoagulants.

An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation

“…26 The characteristic CT features of acute haemorrhage (increased attenuation lesion -white -with respect to normal brain) appear virtually immediately on CT 300 and last for between 5 days and perhaps 3 weeks, 31 depending on the amount of initial blood. 301 Small amounts of blood are broken down more rapidly and can lose their characteristic whiteness by as early as 1 week after the stroke 20,31 becoming isoattenuated and then hypoattenuated (dark) with respect to normal brain.…”

Cerrahi Tedavi Uygulanan Spontan İntraserebral Hematomlar ve Mortalite İlişkisi: 72 Olgunun Retrospektif Değerlendirilmesi

“…Moreover, in cases treated with anticoagulants, the intracerebral hemorrhage ratio is 1.6-3.1% (16) for a variety of reasons. The risk of intracerebral hemorrhage increases 7.6-11% in cases receiving oral anticoagulant treatment compared to other forms of treatment (17)(18)(19). In our study, there were 7 cases (9%) with a determined bleeding disorder.…”

A case of warfarin associated intracerebral hemorrhage with delayed presentation of radiological findings

“…Bu bakımdan oral antikoagülan kullanan ve inme geçirmiş olgularda, özellikle de klinik belirtilerde ilerleme olduğunda vakit geçirilmeden tekrarlayan kontrol radyolojik incelemeler planlanmalıdır. Varfarin kullanan hastalarda hemorajik inme gelişme riski yıllık %1-1.5 oranlarında (2) değişmekte olup, kanamalar parankimal, subdural, epidural veya subaraknoid yerleşimli olabilir (2, [12][13][14][15]21,22). Kanama alanı lokalizasyonları, spontan intraserebral kanama ile benzerlik göstermektedir.…”