Warfarin resumption following anticoagulant-associated intracranial hemorrhage: A systematic review and meta-analysis.

Abstract

BACKGROUND:

This study aims to assess the effect of warfarin resumption in patients who experienced warfarin-associated intracranial hemorrhage (ICH).

METHODS:

We conducted a systematic review and meta-analysis of studies evaluating the outcomes of adult patients who survived warfarin-associated ICH. We included studies that compared patients who resumed warfarin versus those who did not.

RESULTS:

Of 3145 studies screened, ten observational studies were included in the final analysis. Death occurred in 181 of 968 patients (18.7%) who resumed warfarin and 834 of 2579 (32.3%) who did not resume warfarin (RR 0.51, 95% CI 0.34 to 0.76, P=0.0009). Ischemic stroke occurred in 32 of 902 (3.5%) patients who resumed warfarin and 172 of 2467 (7.0%) patients who did not resume warfarin (RR 0.56, 95% CI 0.39 to 0.82, P=0.002). Venous thromboembolism occurred in 4 of 224 (1.8%) patients who resumed warfarin and of 33 of 681 (4.8%) patients who did not resume warfarin (RR 0.39, 95% CI, 0.15 to 1.03, P=0.06). Recurrent ICH occurred in 200 of 2994 (6.7%) patients who resumed warfarin and 358 of 4652 (7.7%) patients who did not resume warfarin (RR 0.89, 95% CI 0.65 to 1.23, P=0.49).

CONCLUSION:

The study suggests that warfarin resumption is associated with significant reduction in ischemic stroke and venous thromboembolism when compared to no warfarin resumption in patients who experience warfarin-associated ICH. Although these results are strongly supportive of restarting anticoagulation, prospective studies are required to confirm our results due to the high likelihood of bias in the included studies.

• Authors: Chatree Chai-Adisaksopha, Alfonso Iorio, Christopher Hillis, Deborah Siegal, Daniel M Witt, Sam Schulman, Mark Crowther
• Journal: Thrombosis research (Thromb Res) Vol. 160 Pg. 97-104 (Dec 2017) ISSN: 1879-2472 [Electronic] United States
• PMID: 29136562 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2017 Elsevier Ltd. All rights reserved.

Chemical References

• Warfarin

Topics

• Female
• Humans
• Intracranial Hemorrhages (chemically induced)
• Male
• Warfarin (pharmacology, therapeutic use)