title: Intracerebral hemorrhage in stroke patients anticoagulated with heparin.
abstract: To characterize the clinical features of patients with acute cerebral infarction who sustained intracerebral hemorrhage related to heparin anticoagulation, we describe 10 patients and review reports of 16 cases. Cardiac-source embolism was identified in seven (70%) of the 10 patients and consisted of atrial fibrillation in six of the seven. The middle cerebral artery territory was affected in nine patients (90%), with moderate-sized or large infarcts by clinical and computed tomographic criteria. The interval between stroke onset and intracerebral hemorrhage was less than 72 hours in 80% of the patients. Intracerebral hemorrhage occurred less than or equal to 24 hours after the time heparin was started in 80% of the patients. The activated partial thromboplastin time closest to the time of intracerebral hemorrhage was greater than 2 x control in seven patients. Our findings in the 10 patients are similar to those of the 16 cases previously reported and suggest that heparin-related intracerebral hemorrhage occurs early after stroke onset, usually with moderate-sized or large infarcts, and with excessive anticoagulation in some patients.
authors.affiliation: Department of Neurology, Boston University School of Medicine, MA 02130.
authors.forename: V L
authors.initials: VL
authors.lastname: Babikian
authors.forename: C S
authors.initials: CS
authors.lastname: Kase
authors.forename: M S
authors.initials: MS
authors.lastname: Pessin
authors.forename: B
authors.initials: B
authors.lastname: Norrving
authors.forename: P B
authors.initials: PB
authors.lastname: Gorelick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002543:Cerebral Hemorrhage / Q000139:chemically induced*; D002544:Cerebral Infarction / Q000188:drug therapy / Q000503:physiopathology; D002561:Cerebrovascular Disorders / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged
chemical_list: D006493:Heparin