title: Reinitiation of anticoagulation after warfarin-associated intracranial hemorrhage and mortality risk: the Best Practice for Reinitiating Anticoagulation Therapy After Intracranial Bleeding (BRAIN) study.
abstract: BACKGROUND
  While warfarin-related intracranial hemorrhage (ICH) occurs in 0.25%-1.1% patients per year, little is known about the practice and outcomes of anticoagulant reinitiation.
  
  
  METHODS
  We studied a cohort of consecutive patients with warfarin-related ICH (intracerebral or subarachnoid) admitted to 13 stroke centres in the Registry of the Canadian Stroke Network between July 2003 and March 2008. We examined patterns of warfarin reinitiation and variables associated with 30-day and 1-year outcomes.
  
  
  RESULTS
  Among the 284 patients studied (mean age 74 ± 12 years), warfarin was restarted in-hospital in 91 patients (32%). Factors associated with restarting warfarin were lower stroke severity (adjusted odds ratio [aOR] 2.07, 95% confidence interval [CI]; 1.20-3.57, P = 0.009) or presence of valve prosthesis (aOR 3.07, 95% CI; 1.29-7.27, P = 0.011). Mortality rates were not higher in those who restarted warfarin in-hospital: 31.9% vs 54.4% (30-day, P < 0.001) and 48% vs 61% (1-year, P = 0.04), and bleeding was not increased. Multivariable predictors of mortality included initial international normalized ratio > 3.0 (aOR, 3.28 [30-day, P < 0.001] and 3.32 [1-year, P = 0.003]), greater stroke severity (aOR, 6.04 [30-day] and 4.22 [1-year]; both P < 0.001), and intraventricular hemorrhage (aOR, 2.19 [30-day; P = 0.03] and 2.04 [1-year; P = 0.04]). In selected patients who reinitiated warfarin, there was no increase in 30-day (aOR, 0.49; P = 0.03) or 1-year mortality (aOR, 0.79; P = 0.43).
  
  
  CONCLUSIONS
  In selected patients at high thrombosis risk, reinitiation of warfarin after ICH did not confer increased mortality or bleeding events.
authors.affiliation: Division of Cardiology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Derek
authors.initials: D
authors.lastname: Yung
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
authors.forename: Eriola
authors.initials: E
authors.lastname: Asllani
authors.forename: Jiming
authors.initials: J
authors.lastname: Fang
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Lee
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000401:mortality; D008297:Male; D009864:Ontario / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D019233:Retreatment; D012307:Risk Factors; D013927:Thrombosis / Q000188:drug therapy* / Q000453:epidemiology; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin