title: Blood pressure burden and outcome in warfarin-related intracerebral hemorrhage.
abstract: Background and purpose Blood pressure reduction is a promising intervention for acute intracerebral hemorrhage, but clinical trials of this treatment often exclude those with anticoagulant-associated intracerebral hemorrhage, leaving it unclear whether this population might benefit. We examined whether persistently elevated blood pressure values (blood pressure burden) over the first 24 h are associated with hematoma expansion and mortality in anticoagulant-associated intracerebral hemorrhage. Methods We retrospectively identified consecutive patients with primary anticoagulant-associated intracerebral hemorrhage (warfarin anticoagulation) who presented within 6 h after symptom onset and a matched set of non-anticoagulant-associated intracerebral hemorrhage patients. Associations between 24 h blood pressure burden, hematoma expansion, and mortality were evaluated using univariable and multivariable logistic regression. Results Sixty-nine anticoagulant-associated intracerebral hemorrhage and 69 matched non-anticoagulant-associated intracerebral hemorrhage patients were included. Hematoma expansion occurred in 25 anticoagulant-associated intracerebral hemorrhage patients (36%) and 15 control patients (22 %; p = 0.091). Twenty-four-hour blood pressure burden was in fact lower in anticoagulant-associated intracerebral hemorrhage than in non-anticoagulant-associated intracerebral hemorrhage patients (p = 0.033). No association was found in anticoagulant-associated intracerebral hemorrhage and non-anticoagulant-associated intracerebral hemorrhage between BP burden, hematoma expansion, and 30-day mortality. Conclusion We found no evidence that higher 24 h blood pressure burden is associated with hematoma expansion or mortality in anticoagulant-associated intracerebral hemorrhage.
authors.affiliation: 1 Department of Neurology, Massachusetts General Hospital, Boston, USA.
authors.forename: Frieder
authors.initials: F
authors.lastname: Schlunk
authors.affiliation: 2 Department of Medicine, Massachusetts General Hospital, Boston, USA.
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.affiliation: 1 Department of Neurology, Massachusetts General Hospital, Boston, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Ayres
authors.affiliation: 1 Department of Neurology, Massachusetts General Hospital, Boston, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Battey
authors.affiliation: 1 Department of Neurology, Massachusetts General Hospital, Boston, USA.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Vashkevich
authors.affiliation: 1 Department of Neurology, Massachusetts General Hospital, Boston, USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Raffeld
authors.affiliation: 1 Department of Neurology, Massachusetts General Hospital, Boston, USA.
authors.forename: Natalia
authors.initials: N
authors.lastname: Rost
authors.affiliation: 1 Department of Neurology, Massachusetts General Hospital, Boston, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Viswanathan
authors.affiliation: 1 Department of Neurology, Massachusetts General Hospital, Boston, USA.
authors.forename: M Edip
authors.initials: ME
authors.lastname: Gurol
authors.affiliation: 1 Department of Neurology, Massachusetts General Hospital, Boston, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Schwab
authors.affiliation: 1 Department of Neurology, Massachusetts General Hospital, Boston, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
authors.affiliation: 1 Department of Neurology, Massachusetts General Hospital, Boston, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.affiliation: 3 Department of Emergency Medicine, Massachusetts General Hospital, Boston, USA.
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Goldstein
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Stroke; blood pressure; intracerebral hemorrhage; stroke subtype; warfarin