The increasing incidence of anticoagulant-associated intracerebral hemorrhage

Flaherty, Matthew L.; Kissela, Brett M.; Woo, Daniel; Kleindorfer, Dawn; Alwell, Kathleen; Sekar, Padmini; Moomaw, Charles J.; Haverbusch, Mary; Broderick, Joseph P.

doi:10.1212/01.wnl.0000250340.05202.8b

Cited by 434 publications

(327 citation statements)

References 39 publications

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“…In that study cerebral bleeding was seen in 5% of the NVE patients and infarctions in 7%, which is a relatively low number of ischemic events compared to other series. A decreasing risk of intracranial haemorrhage over time in PVE patients on anticoagulant therapy has been found [20], contrary to the increasing frequency of anticoagulant associated intracerebral haemorrhage reported during the 1990s in patients with anticoagulant therapy for any indication [21].…”

Section: Discussionmentioning

confidence: 88%

Warfarin therapy and incidence of cerebrovascular complications in left-sided native valve endocarditis

Snygg‐Martin

Rasmussen

Hassager

et al. 2010

Eur J Clin Microbiol Infect Dis

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Anticoagulant therapy has been anticipated to increase risk of cerebrovascular complications (CVC) in native valve endocarditis (NVE). This study investigates the relationship between ongoing oral anticoagulant therapy and incidence of symptomatic CVC in left-sided NVE. In a prospective cohort study CVC incidence was compared between NVE patients with and without ongoing warfarin. Among 587 NVE episodes, 48 (8%) occurred in patients on warfarin. A symptomatic CVC was seen in 144 (25%) patients with only 3 on warfarin.CVC were significantly less frequent in patients on warfarin (6% vs. 26 %, OR 0.20, p=0.006).No increase in haemorrhagic lesions was detected in patients on warfarin. Staphylococcus aureus aetiology

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Section: Discussionmentioning

confidence: 88%

Warfarin therapy and incidence of cerebrovascular complications in left-sided native valve endocarditis

Snygg‐Martin

Rasmussen

Hassager

et al. 2010

Eur J Clin Microbiol Infect Dis

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“…Among other risk factors, alcohol, epilepsy, coagulopathies and CSF shunts may be listed. 13 All these factors were very uncommon in our cases; indeed, they were not considered in the analysis.…”

Section: Discussionmentioning

confidence: 90%

Effect of antiplatelet/anticoagulant agents in elderly patients of chronic subdural hematoma: a case control study from a tertiary care centre

2017

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Background: Bleedings are well known risks of both antiplatelet and anticoagulant therapy and both therapies have historically been considered as risk factors for CSDH. The aim of the study was to evaluate the association between exposure to anticoagulant/antiplatelet therapy and chronic subdural haematoma (CSDH).Methods: Single institution case-control study was conducted in patients older than 60 years who visited our academic tertiary care Emergency Department from January 2012 to December 2016. Patients with CSDH were identified by review of case and controls were selected with a 1:3 ratio for gender, age (60 years), year of admission and recent trauma.Results: There were 124 cases and 372 controls included in the study. Both anticoagulant and antiplatelet agents were associated with an increased risk of CSDH with an OR of 1.22 (CI 95% 0.66-1.54) and 1.12 (CI 95% 0.68-1.54), respectively. While OR was 1.11 (CI 95% 0.54-2.32), 1.21 (CI 95% 0.61-2.45), and 0.53 (CI 95% 0.33-0.78) for patients receiving oral anticoagulants, ADP-antagonists, and Cox-inhibitors, respectively. History of recent trauma was an effective modifier of the association between anticoagulants and CSDH. OR of 1.69 (CI 95% 0.99-2.96) was found for patients with history of trauma and OR of 4.27 (CI 95% 2.23-8.32) for patients without history of trauma.Conclusions: Anticoagulant and antiplatelet therapy have a significant association with an increased risk of CSDH. This association appears even stronger in those patients under anticoagulant therapy, who develop a CSDH in the absence of a recent trauma.

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“…Oral Anticoagulation A population-based study reported a fourfold increase in oral anticoagulation-associated ICH between 1988 and 1999, accounting for as much as 17% of ICH cases in 1999 [57]. The observed increase is most likely due to the increased use of warfarin by patients with atrial fibrillation [58].…”

Section: Anticoagulation Reversalmentioning

confidence: 99%