title: Warfarin-related intraventricular hemorrhage: imaging and outcome.
abstract: OBJECTIVE
  Oral anticoagulation therapy (OAT) with warfarin increases mortality and disability after intracerebral hemorrhage (ICH), the result of increased ICH volume and risk of hematoma expansion. We investigated whether OAT also influences risk of development of intraventricular hemorrhage (IVH), the volume of IVH and IVH expansion, and whether IVH is a substantive mediator of the overall effect of OAT on ICH outcome.
  
  
  METHODS
  We performed a retrospective analysis of a prospectively collected single-center cohort of 1,879 consecutive ICH cases (796 lobar, 865 deep, 153 cerebellar, 15 multiple location, 50 primary IVH) from 1999 to 2009. ICH and IVH volumes at presentation, as well as hematoma expansion (>33% or >6 mL increase) and IVH expansion (>2 mL increase), were determined using established semiautomated methods. Outcome was assessed at 90 days using either the modified Rankin Scale or Glasgow Outcome Scale.
  
  
  RESULTS
  Warfarin use was associated with IVH risk, IVH volume at presentation, and IVH expansion in both lobar and deep ICH (all p < 0.05) in a dose-response relationship with international normalized ratio. Warfarin was associated with poor outcome in both lobar and deep ICH (p < 0.01), and >95% of this effect was accounted for by baseline ICH and IVH volumes, as well as ICH and IVH expansion.
  
  
  CONCLUSIONS
  Warfarin increases IVH volume and risk of IVH expansion in lobar and deep ICH. These findings (along with effects on ICH volume and expansion) likely represent the mechanisms by which anticoagulation worsens ICH functional outcome.
authors: Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA.
authors: A
authors: A
authors: Biffi
authors: T W K
authors: TW
authors: Battey
authors: A M
authors: AM
authors: Ayres
authors: L
authors: L
authors: Cortellini
authors: K
authors: K
authors: Schwab
authors: A J
authors: AJ
authors: Gilson
authors: N S
authors: NS
authors: Rost
authors: A
authors: A
authors: Viswanathan
authors: J N
authors: JN
authors: Goldstein
authors: S M
authors: SM
authors: Greenberg
authors: J
authors: J
authors: Rosand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000401:mortality; D002552:Cerebral Ventricles / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin