| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From Stroke Service and Neurology Clinical Trials Unit, Massachusetts General Hospital, Boston.
Address correspondence and reprint requests to Dr. Jonathan Rosand, Neurology Clinical Trials Unit, Massachusetts General Hospital, WACC 836, 15 Parkman Street, Boston, MA 02114; e-mail: jrosand{at}partners.org
Background: Warfarin increases mortality of intracerebral hemorrhage (ICH). The authors investigated whether this effect reflects increased baseline ICH volume at presentation or increased ICH expansion.
Methods: Subjects were drawn from an ongoing prospective cohort study of ICH outcome. The effect of warfarin on baseline ICH volume was studied in 183 consecutive cases of supratentorial ICH age 
18 years admitted to the emergency department over a 5-year period. Baseline ICH volume was determined using computerized volumetric analysis. The effect of warfarin on ICH expansion (increase in volume 33% of baseline) was analyzed in 70 consecutive cases in whom ICH volumes were measured on all subsequent CT scans up to 7 days after admission. Multivariable analysis was used to determine warfarin’s influence on baseline ICH, ICH expansion, and whether warfarin’s effect on ICH mortality was dependent on baseline volume or subsequent expansion.
Results: There was no effect of warfarin on initial volume. Predictors of larger baseline volume were hyperglycemia (p < 0.0001) and lobar hemorrhage (p < 0.0001). Warfarin patients were at increased risk of death, even when controlling for ICH volume at presentation. Warfarin was the sole predictor of expansion (OR 6.2, 95% CI 1.7 to 22.9) and expansion in warfarin patients was detected later in the hospital course compared with non-warfarin patients (p < 0.001). ICH expansion showed a trend toward increased mortality (OR 3.5, 95% CI 0.7 to 8.9, p = 0.14) and reduced the marginal effect of warfarin on ICH mortality.
Conclusions: Warfarin did not increase ICH volume at presentation but did raise the risk of in-hospital hematoma expansion. This expansion appears to mediate part of warfarin’s effect on ICH mortality.
Received December 5, 2003. Accepted in final form May 14, 2004.
Dr. Rosand has received research support and speaking fees from NovoNordisk A/S.
Related Article
Neurology 2004 63: 946-947.
This article has been cited by other articles:
|
|
 |
|
  A. M. Naidech, B. Jovanovic, S. Liebling, R. K. Garg, S. L. Bassin, B. R. Bendok, R. A. Bernstein, M. J. Alberts, and H. H. Batjer Reduced Platelet Activity Is Associated With Early Clot Growth and Worse 3-Month Outcome After Intracerebral Hemorrhage Stroke, July 1, 2009; 40(7): 2398 - 2401. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Oleinik, J. M. Romero, K. Schwab, M. H. Lev, N. Jhawar, J. E. Delgado Almandoz, E. E. Smith, S. M. Greenberg, J. Rosand, and J. N. Goldstein CT Angiography for Intracerebral Hemorrhage Does Not Increase Risk of Acute Nephropathy Stroke, July 1, 2009; 40(7): 2393 - 2397. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Flaherty, O. Adeoye, P. Sekar, M. Haverbusch, C. J. Moomaw, H. Tao, J. P. Broderick, and D. Woo The Challenge of Designing a Treatment Trial for Warfarin-Associated Intracerebral Hemorrhage Stroke, May 1, 2009; 40(5): 1738 - 1742. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. H. Sansing, S. R. Messe, B. L. Cucchiara, S. N. Cohen, P. D. Lyden, S. E. Kasner, and For the CHANT Investigators Prior antiplatelet use does not affect hemorrhage growth or outcome after ICH Neurology, April 21, 2009; 72(16): 1397 - 1402. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.-H. Lee, W.-S. Ryu, and J.-K. Roh Cerebral microbleeds are a risk factor for warfarin-related intracerebral hemorrhage Neurology, January 13, 2009; 72(2): 171 - 176. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. V. Patel, E. FitzMaurice, R. N. K. Nandigam, P. Auluck, A. Viswanathan, J. N. Goldstein, J. Rosand, S. M. Greenberg, and E. E. Smith Association of Subdural Hematoma With Increased Mortality in Lobar Intracerebral Hemorrhage Arch Neurol, January 1, 2009; 66(1): 79 - 84. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Foerch, K. Arai, G. Jin, K.-P. Park, S. Pallast, K. van Leyen, and E. H. Lo Experimental Model of Warfarin-Associated Intracerebral Hemorrhage Stroke, December 1, 2008; 39(12): 3397 - 3404. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Cucchiara, S. Messe, L. Sansing, S. Kasner, P. Lyden, and for the CHANT Investigators Hematoma Growth in Oral Anticoagulant Related Intracerebral Hemorrhage Stroke, November 1, 2008; 39(11): 2993 - 2996. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. E. Smith, M. Vijayappa, F. Lima, P. Delgado, L. Wendell, J. Rosand, and S. M. Greenberg Impaired visual evoked flow velocity response in cerebral amyloid angiopathy Neurology, October 28, 2008; 71(18): 1424 - 1430. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. O. Claassen, N. Kazemi, A. Y. Zubkov, E. F. M. Wijdicks, and A. A. Rabinstein Restarting Anticoagulation Therapy After Warfarin-Associated Intracerebral Hemorrhage Arch Neurol, October 1, 2008; 65(10): 1313 - 1318. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Y. Zubkov, J. N. Mandrekar, D. O. Claassen, E. M. Manno, E. F. M. Wijdicks, and A. A. Rabinstein Predictors of Outcome in Warfarin-Related Intracerebral Hemorrhage Arch Neurol, October 1, 2008; 65(10): 1320 - 1325. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Flaherty, H. Tao, M. Haverbusch, P. Sekar, D. Kleindorfer, B. Kissela, P. Khatri, B. Stettler, O. Adeoye, C. J. Moomaw, et al. Warfarin use leads to larger intracerebral hematomas Neurology, September 30, 2008; 71(14): 1084 - 1089. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. C. Fric-Shamji, M. F. Shamji, J. Cole, and B. G. Benoit Modifiable risk factors for intracerebral hemorrhage: Study of anticoagulated patients Can Fam Physician, August 1, 2008; 54(8): 1138 - 1139.e4. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. S. Rost, E. E. Smith, Y. Chang, R. W. Snider, R. Chanderraj, K. Schwab, E. FitzMaurice, L. Wendell, J. N. Goldstein, S. M. Greenberg, et al. Prediction of Functional Outcome in Patients With Primary Intracerebral Hemorrhage: The FUNC Score Stroke, August 1, 2008; 39(8): 2304 - 2309. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. FitzMaurice, L. Wendell, R. Snider, K. Schwab, R. Chanderraj, C. Kinnecom, K. Nandigam, N. S. Rost, A. Viswanathan, J. Rosand, et al. Effect of Statins on Intracerebral Hemorrhage Outcome and Recurrence Stroke, July 1, 2008; 39(7): 2151 - 2154. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Viswanathan, P. Patel, R. Rahman, R. N. K. Nandigam, C. Kinnecom, L. Bracoud, J. Rosand, H. Chabriat, S. M. Greenberg, and E. E. Smith Tissue Microstructural Changes Are Independently Associated With Cognitive Impairment in Cerebral Amyloid Angiopathy Stroke, July 1, 2008; 39(7): 1988 - 1992. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Broderick, S. Connolly, E. Feldmann, D. Hanley, C. Kase, D. Krieger, M. Mayberg, L. Morgenstern, C. S. Ogilvy, P. Vespa, et al. REPRINT: Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults: 2007 Update: A Guideline From the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, October 16, 2007; 116(16): e391 - e413. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Broderick, S. Connolly, E. Feldmann, D. Hanley, C. Kase, D. Krieger, M. Mayberg, L. Morgenstern, C. S. Ogilvy, P. Vespa, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults: 2007 Update: A Guideline From the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke, June 1, 2007; 38(6): 2001 - 2023. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Wada, R. I. Aviv, A. J. Fox, D. J. Sahlas, D. J. Gladstone, G. Tomlinson, and S. P. Symons CT Angiography "Spot Sign" Predicts Hematoma Expansion in Acute Intracerebral Hemorrhage Stroke, April 1, 2007; 38(4): 1257 - 1262. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. N. Goldstein, L. E. Fazen, R. Snider, K. Schwab, S. M. Greenberg, E. E. Smith, M. H. Lev, and J. Rosand Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage Neurology, March 20, 2007; 68(12): 889 - 894. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Mayer Recombinant Activated Factor VII for Acute Intracerebral Hemorrhage Stroke, February 1, 2007; 38(2): 763 - 767. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. A. Rabinstein and E. F. M. Wijdicks Determinants of Outcome in Anticoagulation-Associated Cerebral Hematoma Requiring Emergency Evacuation Arch Neurol, February 1, 2007; 64(2): 203 - 206. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Flaherty, B. Kissela, D. Woo, D. Kleindorfer, K. Alwell, P. Sekar, C. J. Moomaw, M. Haverbusch, and J. P. Broderick The increasing incidence of anticoagulant-associated intracerebral hemorrhage Neurology, January 9, 2007; 68(2): 116 - 121. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. I. Aguilar, R. G. Hart, C. S. Kase, W. D. Freeman, B. J. Hoeben, R. C. Garcia, J. E. Ansell, S. A. Mayer, B. Norrving, J. Rosand, et al. Treatment of Warfarin-Associated Intracerebral Hemorrhage: Literature Review and Expert Opinion Mayo Clin. Proc., January 1, 2007; 82(1): 82 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. B. Lee, E. M. Manno, K. F. Layton, and E. F.M. Wijdicks Progression of warfarin-associated intracerebral hemorrhage after INR normalization with FFP. Neurology, October 10, 2006; 67(7): 1272 - 1274. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Foerch, M. Sitzer, H. Steinmetz, T. Neumann-Haefelin, and for the Arbeitsgruppe Schlaganfall Hessen Pretreatment With Antiplatelet Agents Is Not Independently Associated With Unfavorable Outcome in Intracerebral Hemorrhage Stroke, August 1, 2006; 37(8): 2165 - 2167. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. B. Huttner, P. D. Schellinger, M. Hartmann, M. Kohrmann, E. Juettler, J. Wikner, S. Mueller, U. Meyding-Lamade, R. Strobl, U. Mansmann, et al. Hematoma Growth and Outcome in Treated Neurocritical Care Patients With Intracerebral Hemorrhage Related to Oral Anticoagulant Therapy: Comparison of Acute Treatment Strategies Using Vitamin K, Fresh Frozen Plasma, and Prothrombin Complex Concentrates Stroke, June 1, 2006; 37(6): 1465 - 1470. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Davis, J. Broderick, M. Hennerici, N. C. Brun, M. N. Diringer, S. A. Mayer, K. Begtrup, T. Steiner, and for the Recombinant Activated Factor VII Intracere Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage Neurology, April 25, 2006; 66(8): 1175 - 1181. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Flaherty, M. Haverbusch, P. Sekar, B. Kissela, D. Kleindorfer, C. J. Moomaw, L. Sauerbeck, A. Schneider, J. P. Broderick, and D. Woo Long-term mortality after intracerebral hemorrhage Neurology, April 25, 2006; 66(8): 1182 - 1186. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. C. Hemphill III Treating Warfarin-Related Intracerebral Hemorrhage: Is Fresh Frozen Plasma Enough? Stroke, January 1, 2006; 37(1): 6 - 7. [Full Text] [PDF]
|
|
|
|
|
|
S. Tuhrim Aspirin-Use Before ICH: A Potentially Treatable Iatrogenic Coagulopathy? Stroke, January 1, 2006; 37(1): 4 - 5. [Full Text] [PDF]
|
|
|
|
|
|
J. N. Goldstein, S. H. Thomas, V. Frontiero, A. Joseph, C. Engel, R. Snider, E. E. Smith, S. M. Greenberg, and J. Rosand Timing of Fresh Frozen Plasma Administration and Rapid Correction of Coagulopathy in Warfarin-Related Intracerebral Hemorrhage Stroke, January 1, 2006; 37(1): 151 - 155. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Saloheimo, M. Ahonen, S. Juvela, J. Pyhtinen, E.-R. Savolainen, and M. Hillbom Regular Aspirin-Use Preceding the Onset of Primary Intracerebral Hemorrhage is an Independent Predictor for Death Stroke, January 1, 2006; 37(1): 129 - 133. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Steiner, J. Rosand, and M. Diringer Intracerebral Hemorrhage Associated With Oral Anticoagulant Therapy: Current Practices and Unresolved Questions Stroke, January 1, 2006; 37(1): 256 - 262. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Flaherty, D. Woo, M. Haverbusch, C. J. Moomaw, P. Sekar, L. Sauerbeck, B. Kissela, D. Kleindorfer, and J. P. Broderick Potential Applicability of Recombinant Factor VIIa for Intracerebral Hemorrhage Stroke, December 1, 2005; 36(12): 2660 - 2664. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Rosand and S. M. Greenberg The Prognostic Impact of Oral Anticoagulant Treatment in Patients With Intracerebral Hemorrhage--Reply Arch Intern Med, December 13, 2004; 164(22): 2505 - 2505. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
