Restarting anticoagulation therapy after warfarin-associated intracerebral hemorrhage.

Abstract

BACKGROUND:

Reinitiating warfarin sodium therapy in a patient with a recent warfarin-related intracerebral hemorrhage (WAICH) is a difficult clinical decision. Therefore, it is important to assess the outcome of resumption or discontinuation of warfarin therapy after WAICH.

OBJECTIVE:

To compare patients who survived an episode of WAICH and restarted warfarin therapy with a group of WAICH patients who did not resume warfarin therapy. Design, Setting, and Patients We conducted a follow-up study from November 1, 2001, through December 31, 2005, in a cohort from a single center. Long-term outcome was assessed at last clinical follow-up or via questionnaire.

MAIN OUTCOME MEASURES:

Recurrent WAICH and thromboembolic events.

RESULTS:

Fifty-two patients were discharged from the hospital after a diagnosis of WAICH. Four patients were lost to follow-up. Mean follow-up among all patients was 43 (range, 1-108) months. Of the 23 patients who restarted warfarin therapy, 1 had a recurrent nontraumatic WAICH, 2 had traumatic intracerebral hemorrhages, and 2 had major extracranial hemorrhages. Of the 25 patients who did not restart warfarin therapy, 3 had a thromboembolic stroke, 1 had a pulmonary embolus, and 1 had a distal arterial embolus.

CONCLUSIONS:

Restarting warfarin therapy in patients with a recent WAICH is associated with a low risk of recurrence, but patients are subjected to known, substantial risks of warfarin use. Withholding warfarin therapy is associated with a risk of thromboembolization.

• Authors: Daniel O Claassen, Noojan Kazemi, Alexander Y Zubkov, Eelco F M Wijdicks, Alejandro A Rabinstein
• Journal: Archives of neurology (Arch Neurol) Vol. 65 Issue 10 Pg. 1313-8 (Oct 2008) ISSN: 1538-3687 [Electronic] United States
• PMID: 18852344 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Anticoagulants
• Warfarin

Topics

• Adult
• Aged
• Aged, 80 and over
• Anticoagulants (administration & dosage, adverse effects)
• Brain (blood supply, pathology, physiopathology)
• Cerebral Hemorrhage (chemically induced, mortality, physiopathology)
• Clinical Protocols
• Cohort Studies
• Drug Administration Schedule
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Mortality
• Pulmonary Embolism (epidemiology)
• Retrospective Studies
• Risk Assessment
• Stroke (epidemiology)
• Time
• Venous Thromboembolism (drug therapy, prevention & control)
• Warfarin (administration & dosage, adverse effects)