Abstract Details

Title Subtherapeutic Warfarin Does Not Increase Risk of Intracranial Hemorrhage Following Intravenous Thrombolysis in Acute Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 247

Objective

Background BACKGROUND: There is conflicting data on whether subtherapeutic warfarin increases bleeding risk following intravenous thrombolysis. While some studies failed to show an increased risk of bleeding with INR ? 1.7, a recent study from Austria proved otherwise.

Design/Methods DESIGN/METHODS: We reviewed the prospective database of patients evaluated through our telestroke network between November 2008 and June 2012. We included all patients treated with IV t-PA, and divided them into two groups based on whether or not they were on warfarin 24 hour prior to t-PA administration. By definition, those treated with warfarin had subtherapeutic INR. Baseline characteristics, risk factors, time parameters, and laboratory data, were compared between the two groups. We defined poor outcome as mRS > 2 at 3 months, and symptomatic ICH based on the NINDS IV t-PA study criteria. For statistical analysis, we used independent t and Fisher's exact tests.

Results RESULTS: We identified and analyzed 274 thrombolyzed patients; 29 were on warfarin. Those on warfarin were older (years) (75 ± 14 vs. 67 ± 15, p = 0.004), more likely to have atrial fibrillation (48% vs. 13%, p<0.001), and had higher mean admission NIHSS (15 ± 7 vs. 11 ± 7, p = 0.004). Although the mean INR was higher in patients on warfarin (1.2 ± 0.1 vs. 1.0 ± 0.1, p<0.001), none of them had symptomatic ICH. Patients on warfarin were more likely to have poor outcome at 3 months (68% vs. 40%, p = 0.008), likely the result of older age and more severe stroke at baseline.

Conclusions CONCLUSIONS: Subtherapeutic warfarin did not increase the risk of bleeding in our patient population treated with IV t-PA. However, similar to previous studies, these results are hampered by a small number of patients on warfarin receiving thrombolysis.

Authors/Disclosures
Nicolas A. Bianchi, MD (Emory University) PRESENTER	Dr. Bianchi has received personal compensation in the range of $0-$499 for serving as a Consultant for Innovation Hub Enterprises, LLC. The institution of Dr. Bianchi has received research support from Emory Medical Care Foundation.
Mark S. Freedman, MD, FAAN (University of Ottawa)	Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Actelion(Janssen/J&J). Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BiogenIdec. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS/Celgene. Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Inc. Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Actelion (Janssen/J&J). Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Atara Biotherapeutics. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer Healthcare. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for BiogenIdec. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Clene Nanomedicine. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for GRI Bio. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Magenta Therapeutics. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck Serono. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi Genzyme. Dr. Freedman has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi Genzyme. Dr. Freedman has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD Serono. The institution of Dr. Freedman has received research support from Sanofi Genzyme.
	No disclosure on file
Archana Hinduja, MD	Dr. Hinduja has nothing to disclose.
	No disclosure on file
	No disclosure on file
Shadi Yaghi, MD (Hackensack Meridian Health)	Dr. Yaghi has nothing to disclose.

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