title: Improved survival of patients with warfarin-associated intracerebral haemorrhage: a retrospective longitudinal population-based study.
abstract: BACKGROUND
  Warfarin-associated intracerebral haemorrhage carries poor outcome due to rapid haemorrhage growth. Reversal of warfarin anticoagulation with prothrombin complex concentrate has been implemented as an acute treatment option for these subjects.
  
  
  OBJECTIVE
  We investigated whether survival of subjects with warfarin-associated intracerebral haemorrhage had improved after implementation of reversal of warfarin anticoagulation with prothrombin complex concentrate.
  
  
  METHODS
  We identified all subjects with warfarin-associated intracerebral haemorrhage during 1993-2008 among the population of Northern Ostrobothnia, Finland. From 2004 onwards, prothrombin complex concentrate was used in Oulu University Hospital, the only hospital treating intracerebral haemorrhage subjects in the region, to counteract the effect of warfarin in subjects with warfarin-associated intracerebral haemorrhage. We compared the outcomes of subjects admitted during 1993-2003 and 2004-2008 and those treated and not treated with prothrombin complex concentrate. We also explored the predictors for one-year survival of the warfarin-associated intracerebral haemorrhage subjects.
  
  
  RESULTS
  We identified altogether 181 subjects who had intracerebral haemorrhage while on warfarin. One-year survival was significantly (P = 0·031) higher for the 60 subjects admitted during 2004-2008 (43·3%) than for the 121 admitted before 2004 (30·6%). In multivariable analysis, prothrombin complex concentrate treatment reduced one-year case fatality (hazard ratio 0·52, 95% confidence interval 0·29-0·93). Thromboembolic complications did not occur more frequently among those treated with prothrombin complex concentrate.
  
  
  CONCLUSIONS
  The survival of warfarin-associated intracerebral haemorrhage subjects among the population of Northern Ostrobothnia has improved likely because of introduction of prothrombin complex concentrate.
authors.affiliation: Department of Neurology, Oulu University Hospital, Oulu, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Huhtakangas
authors.affiliation: Department of Neurosurgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Sami
authors.initials: S
authors.lastname: Tetri
authors.affiliation: Clinical Neurosciences, University of Helsinki, Helsinki, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Juvela
authors.affiliation: Department of Neurology, Oulu University Hospital, Oulu, Finland.
authors.forename: Pertti
authors.initials: P
authors.lastname: Saloheimo
authors.affiliation: Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
authors.forename: Michaela K
authors.initials: MK
authors.lastname: Bode
authors.affiliation: Department of Neurology, Oulu University Hospital, Oulu, Finland.
authors.forename: Vesa
authors.initials: V
authors.lastname: Karttunen
authors.affiliation: Department of Neurology, Oulu University Hospital, Oulu, Finland.
authors.forename: Anni
authors.initials: A
authors.lastname: Käräjämäki
authors.affiliation: Department of Neurology, Oulu University Hospital, Oulu, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Hillbom
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology*; D003029:Coagulants / Q000627:therapeutic use; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D003029:Coagulants; C025667:prothrombin complex concentrates; D014859:Warfarin