Warfarin related intracranial haemorrhage: A case-controlled study of anticoagulation monitoring prior to spontaneous subdural or intracerebral haemorrhage

Jeffree, Rosalind L.; Gordon, D.H.; Sivasubramaniam, Rahuram; Chapman, A. de Sica

doi:10.1016/j.jocn.2008.10.004

Cited by 37 publications

(19 citation statements)

References 19 publications

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“…Patients with advanced age, prior ischemic stroke, hypertension and intense anticoagulation are at high risk for an anticoagulant-related ICH [1,[19][20][21]. Although many cases with warfarin-related ICH are due to excessive anticoagulation, most ICH occurs at INR b 3.0 [20,22]. Most of our patients were within or below the therapeutic INR range.…”

Section: Discussionmentioning

confidence: 77%

Warfarin-associated intracerebral hemorrhage: Volume, anticoagulation intensity and location

Meretoja

Чурилов

et al. 2013

Journal of the Neurological Sciences

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Section: Discussionmentioning

confidence: 77%

Warfarin-associated intracerebral hemorrhage: Volume, anticoagulation intensity and location

Meretoja

Чурилов

et al. 2013

Journal of the Neurological Sciences

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“…5,9,11,12,15,17 Lower morbidity can be particularly beneficial to patients with serious cardiac and pulmonary Analysis of the subdural evacuating port system for the treatment of subacute and chronic subdural hematomas pathology in whom the inherent risks of general anesthesia are high, as is the probability of a prolonged need for ventilatory support. 3 Furthermore, as many patients with SDHs have medical comorbidities requiring the use of anticoagulant medications, 6,14 the potential for periprocedural blood loss and hemorrhage-related complications can be minimized with a less invasive approach. Additionally, the evacuation of SDHs has been shown to increase the risk of postoperative seizures.…”

mentioning

confidence: 99%

Analysis of the subdural evacuating port system for the treatment of subacute and chronic subdural hematomas

Kenning

Dalfino

German

et al. 2010

JNS

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The SEPS is a safe and effective treatment option for draining subacute and chronic SDHs. The system can be used quickly with local anesthesia only, making it ideal in elderly or sick patients who might not tolerate the physiological stress of a craniotomy under general anesthesia. Computed tomography is useful in predicting which subdural collections are most amenable to SEPS drainage. Specifically, hypodense subdural collections drain more effectively through an SEPS than do mixed density collections. Although significant bleeding after SEPS insertion was uncommon, 1 patient in the series required urgent surgical hematoma evacuation due to iatrogenic injury.

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“…The incidence of CNS hemorrhage in anticoagulated patients with cardiac valves, however, is approximately 0.5 %/year [9, 10]. Furthermore, the results of a retrospective case-controlled study performed by Jeffree et al [11] demonstrated that warfarin use was associated with an increased risk of ICH, despite appropriate INR monitoring and anticoagulation within the therapeutic window. Thus, neurosurgeons are often faced with the difficult task of determining the appropriate duration of withholding anticoagulation when a patient presents with anticoagulation-associated CNS hemorrhage without sufficient evidence-based recommendations to effectively balance the risk of further hemorrhage with the risk of thromboembolism.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Anticoagulation in Patients with Mechanical Heart Valves Following Surgical Treatment of Subdural Hematomas

Amin

Hsu

et al. 2012

Neurocrit Care

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Background Thromboembolic events and anticoagulation-associated bleeding events represent frequent complications following cardiac mechanical valve replacement. Management guidelines regarding the timing for resuming anticoagulation therapy following a surgically treated subdural hematoma (SDH) in patients with mechanical valves remains to be determined. Objective To determine optimal anticoagulation management in patients with mechanical heart valves following treatment of SDH. Methods Outcomes were retrospectively reviewed for 12 patients on anticoagulation therapy for thromboembolic prophylaxis for mechanical cardiac valves who underwent surgical intervention for a SDH at the Johns Hopkins Hospital between 1995 and 2010. Results The mean age at admission was 71 years. All patients had St. Jude’s mechanical heart valves and were receiving anticoagulation therapy. All patients had their anticoagulation reversed with vitamin K and fresh frozen plasma and underwent surgical evacuation. Anticoagulation was withheld for a mean of 14 days upon admission and a mean of 9 days postoperatively. The average length of stay was 19 days. No deaths or thromboembolic events occurred during the hospitalization. Average follow-up time was 50 months, during which two patients had a recurrent SDH. No other associated morbidities occurred during follow-up. Conclusion Interruptions in anticoagulation therapy for up to 3 weeks pose minimal thromboembolic risk in patients with mechanical heart valves. Close follow-up after discharge is highly recommended, as recurrent hemorrhages can occur several weeks after the resumption of anticoagulation.

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Warfarin related intracranial haemorrhage: A case-controlled study of anticoagulation monitoring prior to spontaneous subdural or intracerebral haemorrhage

Cited by 37 publications

References 19 publications

Warfarin-associated intracerebral hemorrhage: Volume, anticoagulation intensity and location

Warfarin-associated intracerebral hemorrhage: Volume, anticoagulation intensity and location

Analysis of the subdural evacuating port system for the treatment of subacute and chronic subdural hematomas

Postoperative Anticoagulation in Patients with Mechanical Heart Valves Following Surgical Treatment of Subdural Hematomas

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