Comparison of hematoma shape and volume estimates in warfarin versus non-warfarin-related intracerebral hemorrhage.
BACKGROUND
Hematoma volume is a major determinant of outcome in patients with intracerebral hemorrhage (ICH). Accurate volume measurements are critical for predicting outcome and are thought to be more difficult in patients with oral anticoagulation-related ICH (OAT-ICH) due to a higher frequency of irregular shape. We examined hematoma shape and methods of volume assessment in patients with OAT-ICH.


METHODS
We performed a case-control analysis of a prospectively identified cohort of consecutive patients with ICH. We retrospectively reviewed 50 consecutive patients with OAT-ICH and 50 location-matched non-OAT-ICH controls. Two independent readers analyzed CT scans for hematoma shape and volume using both ABC/2 and ABC/3 methods. Readers were blinded to all clinical variables including warfarin status. Gold-standard ICH volumes were determined using validated computer-assisted planimetry.


RESULTS
Within this cohort, median INR in patients with OAT-ICH was 3.2. Initial ICH volume was not significantly different between non-OAT-ICH and OAT-ICH (35 +/- 38 cc vs. 53 +/- 56 cc, P = 0.4). ICH shape did not differ by anticoagulation status (round shape in 10% of OAT-ICH vs. 16% of non-OAT-ICH, P = 0.5). The ABC/3 calculation underestimated median volume by 9 (3-28) cc, while the ABC/2 calculation did so by 4 (0.8-12) cc.


CONCLUSIONS
Hematoma shape was not statistically significantly different in patients with OAT-ICH. Among bedside approaches, the standard ABC/2 method offers reasonable approximation of hematoma volume in OAT-ICH and non-OAT-ICH.
Division of Neurology, University of Maryland Medical Center, Baltimore, MD, USA. ksheth@som.umaryland.edu
Kevin N
KN
Sheth
Tracy A
TA
Cushing
Lauren
L
Wendell
Michael H
MH
Lev
Javier M
JM
Romero
Kristin
K
Schwab
Eric E
EE
Smith
Steven M
SM
Greenberg
Jonathan
J
Rosand
Joshua N
JN
Goldstein
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D005260:Female; D006406:Hematoma / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D019934:International Normalized Ratio; D008297:Male; D019095:Point-of-Care Systems; D011379:Prognosis; D012189:Retrospective Studies; D012984:Software; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin