Antithrombotic therapy and predilection for cerebellar hemorrhage.
BACKGROUND
With the recent increase in the use of antithrombotic therapy, intracerebral hemorrhage (ICH) has been found to be a common complication. We determined whether the use of oral antithrombotic therapy and the patients' preexisting comorbidities were predictive of cerebellar hemorrhage (CH; previously reported to be associated with anticoagulants) as compared to other ICH, and whether antithrombotic therapy affected the clinical severity of CH.


METHODS
A study of 327 consecutive patients hospitalized in our institute within 3 days after the onset of ICH, including 38 patients with a CH.


RESULTS
CH accounted for 12% of all ICH, 75% of which occurred in patients on warfarin therapy with an international normalized ratio (INR) for prothrombin time >2.5 (p < 0.0001), and 33% of which occurred in patients on ticlopidine therapy (p = 0.017). Warfarin therapy with an INR >2.5 and high blood glucose on admission were independently predictive of CH as compared to other ICH. In addition, previous ischemic stroke (p = 0.002) and heart diseases (p = 0.018) were more prevalent in patients with CH than in those with other ICH. The number of major arteriosclerotic comorbidities and risk factors was also independently predictive of CH risk.


CONCLUSIONS
We confirmed that warfarin therapy with an INR >2.5 is associated with CH. Patients with CH frequently had arteriosclerotic comorbidities requiring antithrombotic therapy that can complicate their acute management.
Toyoda
Kazunori
K
Department of Cerebrovascular Disease, Cerebrovascular Center and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan. toyoda@hsp.ncvc.go.jp
Okada
Yasushi
Y
Ibayashi
Setsuro
S
Inoue
Tooru
T
Yasumori
Kotaro
K
Fukui
Daisuke
D
Uwatoko
Takeshi
T
Makihara
Noriko
N
Minematsu
Kazuo
K
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001161:Arteriosclerosis / Q000150:complications; D001241:Aspirin / Q000009:adverse effects; D001786:Blood Glucose; D002526:Cerebellar Diseases / Q000139:chemically induced*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced*; D007564:Japan; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications; D013988:Ticlopidine / Q000009:adverse effects; D013997:Time Factors; D014859:Warfarin / Q000009:adverse effects
D000925:Anticoagulants; D001786:Blood Glucose; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D013988:Ticlopidine; D001241:Aspirin