Enlargement of acute intracerebral hematomas in patients on long-term warfarin treatment.
BACKGROUND
The relationship between warfarin administration and the frequent development of enlarged hematomas in patients with acute intracerebral hemorrhage (ICH) is controversial. The present study was carried out to examine this issue.


METHODS
This study reviewed 41 patients with nontraumatic ICH within 24 h after stroke onset from 1999 to 2003 who received long-term warfarin treatment (29 men and 12 women, 70 +/- 12 years old) and 323 patients who had not been on warfarin (177 men and 146 women, 66 +/- 13 years old). The hematoma volume (HV) on admission, final HV, frequency of hematoma enlargement (HE) and other background characteristics were investigated.


RESULTS
Both the HV on admission (p = 0.031) and final HV (p = 0.001) were larger in patients on warfarin than in those not receiving warfarin. HE occurred more frequently (p < 0.001), and mortality at 30 days or at discharge was higher (p = 0.003) in the warfarin group than in the control group. A multivariate adjusted logistic regression analysis showed that warfarin treatment (OR = 5.75, 95% CI = 2.41-13.8, p < 0.001), liver disease (OR = 2.59, 95% CI = 1.12-5.99, p = 0.026), and the National Institutes of Health Stroke Scale score (OR = 1.10, 95% CI = 1.04-1.15, p < 0.001, per 1-score increase) on admission were independently related to HE.


CONCLUSIONS
Acute ICH in patients on long-term warfarin treatment appears to be associated with HE.
Kuwashiro
Takahiro
T
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan. tkuwashi@intmed2.med.kyushu-u.ac.jp
Yasaka
Masahiro
M
Itabashi
Ryo
R
Nakagaki
Hideaki
H
Miyashita
Fumio
F
Naritomi
Hiroaki
H
Minematsu
Kazuo
K
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 / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006406:Hematoma / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy / Q000517:prevention & control; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin