Abstract Details

Title Coumadin-Associated Intracerebral Hemorrhage Is Associated with Higher Risk of Expansion Despite Reversal of Anticoagulation

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P03 - (-)

Poster/Presentation
Number 181

Objective

Background BACKGROUND: Although Coumadin is effective in preventing strokes related to atrial fibrillation, it carries increased risk of ICH. There is conflicting data about the characteristics, behavior, and outcome of ICH related to Coumadin use.

Design/Methods DESIGN/METHODS: Data was retrieved from our prospective database of patients with spontaneous ICH between January 2009 and June 2012. Patients were divided into two groups based on Coumadin intake. Admission hematoma volume was calculated using volumetric CT images through a special software. Clinical and laboratory parameters, medications, CT parameters, and in-hospital mortality were compared between the two groups using Fisher's test and t-test. A multivariate regression analysis was done to identify factors linked with Coumadin related ICH.

Results RESULTS: 198 patients with ICH were identified; 28 patients were on Coumadin. Patients on Coumadin were older (74 ± 11 vs. 62 ± 15, p <0.001), more likely to have coronary heart disease (50% vs. 14%, p <0.001), congestive heart failure (25% vs. 7%, p=0.008), lobar hematoma location (50% vs. 29%, p=0.048) and larger admission hematoma volume (46 ± 42 vs. 29 ± 33, p=0.014) with increased risk of expansion (36% vs. 10%, p=0.001) and mortality (56% vs. 22%, p=0.001). On regression analysis, factors that remained significant were coronary artery disease (OR=4.9, p=0.002, CI:1.8-13.6), age ? 65 years (OR=4.4, p=0.006, CI:1.5-12.4), hematoma expansion (OR=3.8, p=0.025, CI:1.2-12.3), and volume ? 60 ml (OR=3.0, p=0.036, CI:1.1-8.6).

Conclusions CONCLUSIONS: Patients with Coumadin related ICH tend to be older with coronary heart disease, larger admission hematoma volume, and more likelihood to expand despite treatment with vitamin K and FFP. Thus more potent and aggressive reversal of anticoagulation should be considered to reduce the risk of hematoma expansion and potentially reduce mortality and morbidity of such patients.

Authors/Disclosures
Jamil R. Dibu, MD (Cleveland Clinic Abu Dhabi) PRESENTER	No disclosure on file
Archana Hinduja, MD	Dr. Hinduja has nothing to disclose.
Eugene Y. Achi, MD (Cleveland Clinic Abu Dhabi)	No disclosure on file
Anand V. Patel, MD (University of Texas Medical Branch)	Dr. Patel has nothing to disclose.
	No disclosure on file
Shadi Yaghi, MD (Hackensack Meridian Health)	Dr. Yaghi has nothing to disclose.
	No disclosure on file

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