Oral-anticoagulant-related intracerebral hemorrhage.
BACKGROUND
The characteristics, management and outcomes of patients who suffer intracerebral hemorrhage (ICH) while taking oral anticoagulants (OAC) are relatively unreported.


METHODS
Retrospective cohort study of consecutive cases with ICH associated with OAC.


METHODS
A university-affiliated tertiary care hospital in Ontario, Canada.


METHODS
368 charts of individuals with a discharge diagnosis of ICH (ICD-9 code 431) between January 1993 and May 1998 were reviewed.


RESULTS
20 (5.4%, 95% confidence interval (CI): 3.1-7.7%) of the 368 ICHs occurred in people taking OAC. The median age of patients on OAC was 74 years (S.D.+/-9.8), and 70% (95% CI: 49-91%) were female. The median INR at presentation was 3.4 (intraquartile (IQR) range 2.2-4.4). Nine of 20 (45%) patients had INR values which exceeded the target range. The case fatality rate was 45% (95% CI: 23-67%). Approximately 2.8 years after the initial ICH, 9 of the 11 patients who survived the initial ICH were still alive, and 6 had restarted OAC.


CONCLUSIONS
ICH is a serious complication in patients taking OAC, and the case-fatality rate is high. Given the increasing use of OAC in patients with cardiovascular disease, the relative benefits and risks of this therapy must be weighed carefully.
Punthakee
Xerxes
X
Department of Preventive Cardiology and Therapeutics, Hamilton Health Sciences Corporation, McMaster University, 237 Barton Street East, Hamilton, Ontario, Canada L8L 2X2.
Doobay
Jaya
J
Anand
Sonia S
SS
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D002543:Cerebral Hemorrhage / Q000097:blood / Q000139:chemically induced* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
D000925:Anticoagulants; D014859:Warfarin