title: Symptomatic intracerebral hemorrhage among eligible warfarin-treated patients receiving intravenous tissue plasminogen activator for acute ischemic stroke.
abstract: OBJECTIVE
  To determine whether warfarin-treated patients with an international normalized ratio less than 1.7 who receive intravenous tissue plasminogen activator for acute ischemic stroke are at increased risk for symptomatic intracerebral hemorrhage.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Academic hospital.
  
  
  METHODS
  Consecutive patients with acute ischemic stroke who are treated with intravenous tissue plasminogen activator.
  
  
  METHODS
  Symptomatic intracerebral hemorrhage.
  
  
  RESULTS
  One hundred seven patients were included (mean age, 69.2 years; 43.9% men; median National Institutes of Health Stroke Scale score, 14; median onset-to-treatment time, 140 minutes; baseline warfarin use, 12.1%). The median international normalized ratio was 1.04 (range, 0.82-1.61). The overall rate of symptomatic intracerebral hemorrhage was 6.5%, but it was nearly 10-fold higher among patients taking warfarin compared with those not taking warfarin at baseline (30.8% vs 3.2%, respectively; P = .004). Baseline warfarin use remained strongly associated with symptomatic intracerebral hemorrhage (P = .004) after adjusting for relevant covariates, including age, atrial fibrillation, National Institutes of Health Stroke Scale score, and international normalized ratio.
  
  
  CONCLUSIONS
  Despite an international normalized ratio less than 1.7, warfarin-treated patients are more likely than those not taking warfarin to experience symptomatic intracerebral hemorrhage following treatment with intravenous tissue plasminogen activator. Larger studies in this subgroup are warranted.
authors.affiliation: Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois 60612, USA. shyam_prabhakaran@rush.edu
authors.forename: Shyam
authors.initials: S
authors.lastname: Prabhakaran
authors.forename: Juan
authors.initials: J
authors.lastname: Rivolta
authors.forename: Julio R
authors.initials: JR
authors.lastname: Vieira
authors.forename: Fred
authors.initials: F
authors.lastname: Rincon
authors.forename: Joshua
authors.initials: J
authors.lastname: Stillman
authors.forename: Randolph S
authors.initials: RS
authors.lastname: Marshall
authors.forename: Ji Y
authors.initials: JY
authors.lastname: Chong
mesh_terms: D000208:Acute Disease / Q000628:therapy; D000925:Anticoagulants / Q000009:adverse effects; D002545:Brain Ischemia / Q000188:drug therapy*; D002536:Cerebral Arteries / Q000187:drug effects / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000503:physiopathology; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin; D010959:Tissue Plasminogen Activator