title: Questionable reversal of anticoagulation in the therapeutic management of cerebral haemorrhage associated with vitamin K antagonists.
abstract: Reversal of anticoagulation is recommended to correct the international normalised ratio (INR) for patients with intracranial haemorrhage (ICH) associated with vitamin K antagonists (VKA). However, the validity of such treatment is debated. We sought to identify, prospectively, the prognostic effect of VKA-ICH treatment in a cohort of patients (n=71; median age 78 years, range 20-89; 52% males). Data collated were: baseline characteristics, treatments, baseline and post-treatment INR, haematoma volume, and haematoma enlargement. Treatment effects and prognostic factor assessment were in relation to mortality and functional outcomes. On admission, the patients had a median score of 9 [p25; p75 of 5; 20] on the National Institute of Health Stroke Scale (NIHSS) and a mean INR of 2.7 (range: 0.9 - 10.8). Haematoma volume (34.6 cm³; SD: 24.9) correlated with NIHSS (r = 0.55; p<0.001) but not with INR. Anticoagulation reversal treatment was administered in 83% of patients. INR <1.5 was achieved in 60.7% of cases. Death or dependency at three months was 76%. Neither baseline INR, anticoagulation reversal nor haematoma enlargement were related to mortality or functional outcome. The only independent prognostic factor was clinical severity on admission. Baseline NIHSS predicted mortality (OR: 1.18; 95%CI: 1.09-1.27), independence (OR: 0.83; 95%CI: 0.74-0.94) and neurological recovery (NIHSS 0-1) (OR: 0.83; 95%CI: 0.73-0.95). The data indicate that VKA-ICH had a poor prognosis. Treatment and INR correction did not appear to affect outcomes.
authors.affiliation: María Alonso de Leciñana, MD, PhD, Stroke Unit, Department of Neurology, University Hospital Ramón y Cajal, Ctra de Colmenar Km 9,100, 28034 Madrid, Spain, Tel.: +34 670754255, Fax: +34 913369016, E-mail: malecinanacases@salud.madrid.org.
authors.forename: Maria
authors.initials: M
authors.lastname: Alonso de Leciñana
authors.forename: Nuria
authors.initials: N
authors.lastname: Huertas
authors.forename: José A
authors.initials: JA
authors.lastname: Egido
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
authors.forename: Ana
authors.initials: A
authors.lastname: García
authors.forename: Gerardo
authors.initials: G
authors.lastname: Ruiz-Ares
authors.forename: Exuperio
authors.initials: E
authors.lastname: Díez-Tejedor
authors.forename: Blanca
authors.initials: B
authors.lastname: Fuentes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D006406:Hematoma / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: Intracerebral haemorrhage; oral anticoagulants; prothrombin complex concentrate; vitamin K antagonists