SPECIAL ARTICLETreatment of Warfarin-Associated Intracerebral Hemorrhage: Literature Review and Expert Opinion
Section snippets
METHODS
A computerized search of the OVID database from January 1996 to January 2006 combining the terms warfarin or anticoagulation with intracranial hemorrhage or intracerebral hemorrhage was undertaken. The reference lists from recent review articles were also examined. From the elicited sources, 4 of the coauthors (R.G.H., C.S.K., M.I.A., and W.D.F.) drafted the narrative review of the recent literature. Because information about the practical clinical pharmacology of prothrombin complex
Frequency of Warfarin-Associated ICH
Warfarin-associated ICH is not rare at hospitals that serve large numbers of patients undergoing anticoagulation and appears to be increasing.2 A survey of consecutive patients with supratentorial ICH admitted to the Massachusetts General Hospital between 1994 and 2001 found that 24% were taking warfarin, an average of 1 patient per month with warfarin-associated ICH admitted to this tertiary care hospital.16 Other studies of ICH in the middle to late 1990s reported that approximately 12%
DISCUSSION
Warfarin-associated ICH is a devastating iatrogenic problem whose frequency is increasing because more elderly people are receiving anticoagulation. It is a tragic irony that anticoagulation given to prevent ischemic stroke can be complicated by severe, usually lethal, hemorrhagic stroke as its most dreaded complication. In the absence of randomized trials, management is based on a combination of anecdotal experience, pathophysiologic constructs, and expert opinion. Not surprisingly, the
CONCLUSION
Reasonable management of warfarin-associated ICH includes a range of treatments in the absence of adequate data, as defined by the expert opinions delineated herein. Time to reversal of anticoagulation is crucial, and whatever treatment strategy is endorsed should be planned in advance in collaboration with local emergency medicine physicians and be used expeditiously. Randomized trials that address the management of warfarin-associated ICH are needed.
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2018, World NeurosurgeryCitation Excerpt :Warfarin is now the most widely used anticoagulant to decrease the risk of thromboembolic events.5 After diagnosis of warfarin-related CSDH, discontinuation of anticoagulation therapy and prompt correction of the prolonged international normalized ratio (INR) are recommended to limit hematoma expansion.6-10 Although most cases of CSDH resolve after burr-hole drainage, 10%–20% of surgically treated patients experience postoperative recurrence requiring reoperation.4
NovoNordisk manufactures recombinant factor VIIa. Drs Mayer, Rosand, and Steiner have served as consultants to NovoNordisk and are members of the Recombinant Factor VII ICH Study Team.
All authored materials constitute the personal statements of Maj Barbara J. Hoeben and are not intended to constitute an endorsement by Wilford Hall Medical Center, Lackland AFB, or any other federal government entity.