title: Individual characteristics and management decisions affect outcome of anticoagulated patients with intracranial hemorrhage.
abstract: BACKGROUND
  Anticoagulated patients with intracranial hemorrhage represent a major management challenge. Our goal is to determine how patient characteristics and management decisions influence outcome.
  
  
  METHODS
  A systematic review of the literature identified relevant reported cases. Variables describing patient characteristics, management, and outcome were extracted. Statistical analyses were carried out using analysis of variance and Fisher's exact test.
  
  
  RESULTS
  A total of 242 patients from our updated dataset met inclusion criteria. Tissue plane of the hemorrhage (P < 0.0001), indication for anticoagulation (P < 0.0001), type of anticoagulant (P = 0.0173), and history of hypertension (P = 0.0418) were significantly associated with outcome. Older age (P < 0.0001), supratentorial index hemorrhages (P = 0.0018), failure to restart anticoagulation (P < 0.0001), and larger hematoma volume (P < 0.0001) were associated with worse outcome. Surgical evacuation was associated with improved outcome (P = 0.0011). There was a trend toward an association between the occurrence of a hemorrhagic or thromboembolic complication and risk of death (P = 0.0882). Sex and sidedness of the index hemorrhage were not significantly associated with outcome.
  
  
  CONCLUSIONS
  Our results provide prognostic information that may assist management of these patients. Our results also suggest that it may be unwise to withhold anticoagulation indefinitely after an index hemorrhage. As thromboembolic or hemorrhagic complications may be associated with worse outcome, efforts to avoid them may be wise. The studies that comprise our dataset have important limitations and a prospective study will be required to confirm these results.
authors: Division of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors: Gregory W J
authors: GW
authors: Hawryluk
authors: Division of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Lyndhurst Centre, Toronto Rehabilitation Institute, University of Toronto, Toronto, Ontario, Canada.
authors: Julio C
authors: JC
authors: Furlan
authors: Division of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
authors: James W
authors: JW
authors: Austin
authors: Division of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada; Spinal Program, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: michael.fehlings@uhn.on.ca.
authors: Michael G
authors: MG
authors: Fehlings
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000188:drug therapy*; D020767:Intracranial Thrombosis / Q000150:complications / Q000188:drug therapy*; D020521:Stroke / Q000150:complications / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Central nervous system; Complication; Hemorrhage; Optimization; Outcome; Stroke; Thrombosis