Questionable reversal of anticoagulation in the therapeutic management of cerebral haemorrhage associated with vitamin K antagonists

Maria Alonso de Leciñana; Nuria Huertas; Jose A. Egido; Alfonso Muriel; Ana García; Gerardo Ruiz-Ares; Exuperio Díez-Tejedor; Blanca Fuentes

doi:10.1160/TH13-04-0318

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2013; 110(06): 1145-1151
DOI: 10.1160/TH13-04-0318

Blood coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Questionable reversal of anticoagulation in the therapeutic management of cerebral haemorrhage associated with vitamin K antagonists

Authors

Maria Alonso de Leciñana

¹Stroke Unit, Department of Neurology, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
Nuria Huertas

²Department of Neurology, Hospital Severo Ochoa, Leganés, Spain
Jose A. Egido

³Stroke Unit, Department of Neurology, University Hospital San Carlos, IdISSC Madrid, Spain
Alfonso Muriel

⁴Department of Clinical Biostatistics, University Hospital Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain
Ana García

³Stroke Unit, Department of Neurology, University Hospital San Carlos, IdISSC Madrid, Spain
Gerardo Ruiz-Ares

⁵Department of Neurology and Stroke Centre, University Hospital La Paz, Universidad Autonoma de Madrid, IdiPAZ Health Research Institute, Madrid, Spain
Exuperio Díez-Tejedor

⁵Department of Neurology and Stroke Centre, University Hospital La Paz, Universidad Autonoma de Madrid, IdiPAZ Health Research Institute, Madrid, Spain
Blanca Fuentes

⁵Department of Neurology and Stroke Centre, University Hospital La Paz, Universidad Autonoma de Madrid, IdiPAZ Health Research Institute, Madrid, Spain

Abstract

Summary

Reversal of anticoagulation is recommended to correct the international normalised ratio (INR) for patients with intracranial haemorrhage (ICH) associated with vitamin K antagonists (VKA). However, the validity of such treatment is debated. We sought to identify, prospectively, the prognostic effect of VKA-ICH treatment in a cohort of patients (n=71; median age 78 years, range 20–89; 52% males). Data collated were: baseline characteristics, treatments, baseline and post-treatment INR, haematoma volume, and haematoma enlargement. Treatment effects and prognostic factor assessment were in relation to mortality and functional outcomes. On admission, the patients had a median score of 9 [p25; p75 of 5; 20] on the National Institute of Health Stroke Scale (NIHSS) and a mean INR of 2.7 (range: 0.9 – 10.8). Haematoma volume (34.6 cm³; SD: 24.9) correlated with NIHSS (r = 0.55; p<0.001) but not with INR. Anticoagulation reversal treatment was administered in 83% of patients. INR <1.5 was achieved in 60.7% of cases. Death or dependency at three months was 76%. Neither baseline INR, anticoagulation reversal nor haematoma enlargement were related to mortality or functional outcome. The only independent prognostic factor was clinical severity on admission. Baseline NIHSS predicted mortality (OR: 1.18; 95%CI: 1.09–1.27), independence (OR: 0.83; 95%CI: 0.74–0.94) and neurological recovery (NIHSS 0–1) (OR: 0.83; 95%CI: 0.73–0.95). The data indicate that VKA-ICH had a poor prognosis. Treatment and INR correction did not appear to affect outcomes.

Keywords

Intracerebral haemorrhage - oral anticoagulants - vitamin K antagonists - prothrombin complex concentrate

Full Text

References

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