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Intracerebral hemorrhage during anticoagulation with vitamin K antagonists: a consecutive observational study

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Abstract

Intracerebral hemorrhage (ICH) is the most devastating complication of oral anticoagulation (OAC). As the number of patients on long-term OAC is expected to rise, the proportion of intracerebral hemorrhage related to OAC (OAC-ICH) in relation to spontaneous ICH (spont-ICH) is expected to increase as well. We determined the proportion of OAC-ICH in consecutive stroke patients and explored differences between OAC-ICH and spont-ICH regarding initial volume, hematoma expansion and outcome. Our prospective study consecutively enrolled patients with supra- and infratentorial ICH. The National Institute of Health Stroke Scale Score and the modified Rankin Scale (mRS) score at baseline and after 3 months, medical history and demographic variables were recorded. All admission and follow-up CTs/MRIs were analysed regarding ICH volume using the ABC/2-method. Intraventricular hemorrhage (IVH) was quantified using the Graeb score. Within 19 months, 2,282 patients were admitted to our ER. 206 ICH patients were included. Overall, 24.8 % of all ICH were related to OAC. Compared to patients with spont-ICH, OAC-ICH patients were older (p = 0.001), more frequently had initial extension of ICH into the ventricles (p = 0.05) or isolated primary IVH (p = 0.03) and a higher Graeb score upon admission (p = 0.01). In contrast, initial ICH volume (p = 0.16) and ICH expansion (p = 0.9) in those receiving follow-up imaging (n = 152) did not differ between the two groups. After correction for age, there was a trend towards poorer outcome in OAC-ICH (p = 0.08). One-fourth of all ICH are related to OAC. Initial extension of ICH into the ventricles and primary IVH are more frequent in OAC-ICH. The rate of hematoma expansion in OAC-ICH patients is similar to non-anticoagulated ICH patients.

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Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Department of Neurology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany

    S. Horstmann, T. Rizos, M. Lauseker, W. Hacke & R. Veltkamp

  2. Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany

    M. Möhlenbruch

  3. Department for Child and Adolescent Psychiatry, Johannes Gutenberg-University, Mainz, Germany

    E. Jenetzky

  4. Klinikum Höchst GmbH, Frankfurt a. M., Germany

    Th. Steiner

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  1. S. Horstmann
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  2. T. Rizos
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  3. M. Lauseker
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  4. M. Möhlenbruch
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  5. E. Jenetzky
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  6. W. Hacke
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  7. Th. Steiner
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  8. R. Veltkamp
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Correspondence to R. Veltkamp.

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Horstmann, S., Rizos, T., Lauseker, M. et al. Intracerebral hemorrhage during anticoagulation with vitamin K antagonists: a consecutive observational study. J Neurol 260, 2046–2051 (2013). https://doi.org/10.1007/s00415-013-6939-6

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  • DOI: https://doi.org/10.1007/s00415-013-6939-6

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