title: Nationwide survey of neuro-specialists' opinions on anticoagulant therapy after intracerebral hemorrhage in patients with atrial fibrillation.
abstract: OBJECTIVE
  A nationwide survey was conducted regarding anticoagulant therapy in patients with acute intracerebral hemorrhage (ICH) on warfarin with nonvalvular atrial fibrillation (NVAF).
  
  
  METHODS
  A questionnaire on standard therapeutic strategy for warfarin-related ICH in patients with NVAF was mailed to 416 institutes.
  
  
  RESULTS
  A total of 329 physicians (79%) responded with a completed questionnaire. On admission, all respondents stopped warfarin medication and 94% normalized the international normalized ratio (INR) mainly by Vitamin K (63%), followed by fresh frozen plasma (20%), and prothrombin complex concentrate (10%). Afterwards, 91% of the respondents restarted anticoagulation and 3% used antiplatelet for prevention of thromboembolism, but the remaining 6% disagreed with restarting antithrombotic therapy. As contraindications for resuming anticoagulation, recurrent ICH (59%) and poor functional condition (59%) were often chosen. Of those who restarted anticoagulation, the timing was within 4 days in 7%, 5 to 7 days in 21%, 8 to 14 days in 25%, 15 to 28 days in 28% and 29 days or later in 18%. The major key finding on follow-up CT to restart anticoagulation was the absorption tendency of hematomas (47%). When restarting anticoagulation, 76% of the respondents used warfarin alone and 20% used either unfractionated heparin plus warfarin or heparin alone.
  
  
  CONCLUSIONS
  A large majority of respondents responsible for ICH management stopped oral warfarin medication and normalized INR on admission, and restarted anticoagulation after acute ICH in patients with NVAF. However, the strategies to normalize INR and to restart anticoagulant therapy varied greatly and depended on each individual physician's decision.
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Maeda
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Koga
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okada
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamagami
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okuda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shiokawa
authors.forename: Eisuke
authors.initials: E
authors.lastname: Furui
authors.forename: Jyoji
authors.initials: J
authors.lastname: Nakagawara
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Nezu
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
mesh_terms: D000208:Acute Disease; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000188:drug therapy*; D002543:Cerebral Hemorrhage / Q000188:drug therapy*; D019538:Health Care Surveys; D006801:Humans; D007564:Japan; D009462:Neurology / Q000706:statistics & numerical data*; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin