Effect of anticoagulant and antiplatelet therapy in patients with spontaneous intra-cerebral hemorrhage: Does medication use predict worse outcome?

Latha G. Stead, Anunaya Jain, Fernanda Bellolio, Adetolu O. Odufuye, Ravneet K. Dhillon, Veena Manivannan, Rachel M. Gilmore, Alejandro Rabinstein, Raghav Chandra, Luis A. Serrano, Neeraja Yerragondu, Balavani Palamari, Wyatt W. Decker

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Objectives: To assess the impact of anticoagulants and antiplatelet agents on the severity and outcome of spontaneous non-traumatic intra-cerebral hemorrhage (ICH). To evaluate associations between reversal of anticoagulation and mortality/morbidity in these patients. Methods: Data was collected on a consecutive cohort of adults presenting with ICH to an academic Emergency Department over a 3-year period starting January 2006. Results: The final cohort of 245 patients consisted of 125 females (51.1%). The median age of the cohort was 73 years [inter-quartile (IQR) range of 59-82 years]. Antiplatelet (AP) use was seen in 32.6%, 18.4% were using anticoagulant (AC) and 8.9% patients were on both drugs (AC + AP). Patients on AC had significantly higher INR (median 2.3) and aPTT (median 31 s) when compared to patients not on AP/AC (median INR 1.0, median aPTT 24 s; p < 0.001). Similarly patients on AC + AP also had higher INR (median 1.9) and aPTT (median 30 s) when compared to those not on AC/AP (p < 0.001). Hemorrhage volumes were significantly higher for patients on AC alone (median 64.7 cm3) when compared to those not on either AC/AP (median 27.2 cm3; p = 0.05). The same was not found for patients using AP (median volume 20.5 cm3; p = 0.813), or both AC + AP (median volume 27.7 cm3; p = 0.619). Patients on AC were 1.43 times higher at risk to have intra-ventricular extension of hemorrhage (IVE) as compared to patients not on AC/AP (95% CI 1.04-1.98; p = 0.035). There was no relationship between the use of AC/AP/AC + AP and functional outcome of patients. Patients on AC were 1.74 times more likely to die within 7 days (95% CI 1.0-3.03; p = 0.05). No relationship was found between use of AP or AC + AP use and mortality. Of the 82 patients with INR > 1.0, 52 patients were given reversal (minimum INR 1.4, median 2.3). Therapy was heterogeneous, with fresh frozen plasma (FFP) being the most commonly used agent (86.5% patients, median dose 4 U). Vitamin K, activated factor VIIa and platelets were the other agents used. Post reversal, INR normalized within 24 h (median 1.2, IQR 1.1-1.3). There was no association between reversal and volume of hemorrhage, IVE, early mortality (death < 7 days) or functional outcome. Conclusions: Anticoagulated patients were at 1.7 times higher risk of early mortality after ICH. Reversal of INR to normal did not influence mortality or functional outcome.

Original languageEnglish (US)
Pages (from-to)275-281
Number of pages7
JournalClinical Neurology and Neurosurgery
Volume112
Issue number4
DOIs
StatePublished - May 2010

Fingerprint

Cerebral Hemorrhage
Anticoagulants
International Normalized Ratio
Mortality
Platelet Aggregation Inhibitors
Therapeutics
Factor VIIa
Vitamin K
Proxy
Hospital Emergency Service
Blood Platelets
Hemorrhage
Morbidity

Keywords

  • Anticoagulants
  • Cerebral hemorrhage
  • Platelet aggregation inhibitors

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Effect of anticoagulant and antiplatelet therapy in patients with spontaneous intra-cerebral hemorrhage : Does medication use predict worse outcome? / Stead, Latha G.; Jain, Anunaya; Bellolio, Fernanda; Odufuye, Adetolu O.; Dhillon, Ravneet K.; Manivannan, Veena; Gilmore, Rachel M.; Rabinstein, Alejandro; Chandra, Raghav; Serrano, Luis A.; Yerragondu, Neeraja; Palamari, Balavani; Decker, Wyatt W.

In: Clinical Neurology and Neurosurgery, Vol. 112, No. 4, 05.2010, p. 275-281.

Research output: Contribution to journalArticle

Stead, LG, Jain, A, Bellolio, F, Odufuye, AO, Dhillon, RK, Manivannan, V, Gilmore, RM, Rabinstein, A, Chandra, R, Serrano, LA, Yerragondu, N, Palamari, B & Decker, WW 2010, 'Effect of anticoagulant and antiplatelet therapy in patients with spontaneous intra-cerebral hemorrhage: Does medication use predict worse outcome?', Clinical Neurology and Neurosurgery, vol. 112, no. 4, pp. 275-281. https://doi.org/10.1016/j.clineuro.2009.12.002
Stead, Latha G. ; Jain, Anunaya ; Bellolio, Fernanda ; Odufuye, Adetolu O. ; Dhillon, Ravneet K. ; Manivannan, Veena ; Gilmore, Rachel M. ; Rabinstein, Alejandro ; Chandra, Raghav ; Serrano, Luis A. ; Yerragondu, Neeraja ; Palamari, Balavani ; Decker, Wyatt W. / Effect of anticoagulant and antiplatelet therapy in patients with spontaneous intra-cerebral hemorrhage : Does medication use predict worse outcome?. In: Clinical Neurology and Neurosurgery. 2010 ; Vol. 112, No. 4. pp. 275-281.
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abstract = "Objectives: To assess the impact of anticoagulants and antiplatelet agents on the severity and outcome of spontaneous non-traumatic intra-cerebral hemorrhage (ICH). To evaluate associations between reversal of anticoagulation and mortality/morbidity in these patients. Methods: Data was collected on a consecutive cohort of adults presenting with ICH to an academic Emergency Department over a 3-year period starting January 2006. Results: The final cohort of 245 patients consisted of 125 females (51.1{\%}). The median age of the cohort was 73 years [inter-quartile (IQR) range of 59-82 years]. Antiplatelet (AP) use was seen in 32.6{\%}, 18.4{\%} were using anticoagulant (AC) and 8.9{\%} patients were on both drugs (AC + AP). Patients on AC had significantly higher INR (median 2.3) and aPTT (median 31 s) when compared to patients not on AP/AC (median INR 1.0, median aPTT 24 s; p < 0.001). Similarly patients on AC + AP also had higher INR (median 1.9) and aPTT (median 30 s) when compared to those not on AC/AP (p < 0.001). Hemorrhage volumes were significantly higher for patients on AC alone (median 64.7 cm3) when compared to those not on either AC/AP (median 27.2 cm3; p = 0.05). The same was not found for patients using AP (median volume 20.5 cm3; p = 0.813), or both AC + AP (median volume 27.7 cm3; p = 0.619). Patients on AC were 1.43 times higher at risk to have intra-ventricular extension of hemorrhage (IVE) as compared to patients not on AC/AP (95{\%} CI 1.04-1.98; p = 0.035). There was no relationship between the use of AC/AP/AC + AP and functional outcome of patients. Patients on AC were 1.74 times more likely to die within 7 days (95{\%} CI 1.0-3.03; p = 0.05). No relationship was found between use of AP or AC + AP use and mortality. Of the 82 patients with INR > 1.0, 52 patients were given reversal (minimum INR 1.4, median 2.3). Therapy was heterogeneous, with fresh frozen plasma (FFP) being the most commonly used agent (86.5{\%} patients, median dose 4 U). Vitamin K, activated factor VIIa and platelets were the other agents used. Post reversal, INR normalized within 24 h (median 1.2, IQR 1.1-1.3). There was no association between reversal and volume of hemorrhage, IVE, early mortality (death < 7 days) or functional outcome. Conclusions: Anticoagulated patients were at 1.7 times higher risk of early mortality after ICH. Reversal of INR to normal did not influence mortality or functional outcome.",
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TY - JOUR

T1 - Effect of anticoagulant and antiplatelet therapy in patients with spontaneous intra-cerebral hemorrhage

T2 - Does medication use predict worse outcome?

AU - Stead, Latha G.

AU - Jain, Anunaya

AU - Bellolio, Fernanda

AU - Odufuye, Adetolu O.

AU - Dhillon, Ravneet K.

AU - Manivannan, Veena

AU - Gilmore, Rachel M.

AU - Rabinstein, Alejandro

AU - Chandra, Raghav

AU - Serrano, Luis A.

AU - Yerragondu, Neeraja

AU - Palamari, Balavani

AU - Decker, Wyatt W.

PY - 2010/5

Y1 - 2010/5

N2 - Objectives: To assess the impact of anticoagulants and antiplatelet agents on the severity and outcome of spontaneous non-traumatic intra-cerebral hemorrhage (ICH). To evaluate associations between reversal of anticoagulation and mortality/morbidity in these patients. Methods: Data was collected on a consecutive cohort of adults presenting with ICH to an academic Emergency Department over a 3-year period starting January 2006. Results: The final cohort of 245 patients consisted of 125 females (51.1%). The median age of the cohort was 73 years [inter-quartile (IQR) range of 59-82 years]. Antiplatelet (AP) use was seen in 32.6%, 18.4% were using anticoagulant (AC) and 8.9% patients were on both drugs (AC + AP). Patients on AC had significantly higher INR (median 2.3) and aPTT (median 31 s) when compared to patients not on AP/AC (median INR 1.0, median aPTT 24 s; p < 0.001). Similarly patients on AC + AP also had higher INR (median 1.9) and aPTT (median 30 s) when compared to those not on AC/AP (p < 0.001). Hemorrhage volumes were significantly higher for patients on AC alone (median 64.7 cm3) when compared to those not on either AC/AP (median 27.2 cm3; p = 0.05). The same was not found for patients using AP (median volume 20.5 cm3; p = 0.813), or both AC + AP (median volume 27.7 cm3; p = 0.619). Patients on AC were 1.43 times higher at risk to have intra-ventricular extension of hemorrhage (IVE) as compared to patients not on AC/AP (95% CI 1.04-1.98; p = 0.035). There was no relationship between the use of AC/AP/AC + AP and functional outcome of patients. Patients on AC were 1.74 times more likely to die within 7 days (95% CI 1.0-3.03; p = 0.05). No relationship was found between use of AP or AC + AP use and mortality. Of the 82 patients with INR > 1.0, 52 patients were given reversal (minimum INR 1.4, median 2.3). Therapy was heterogeneous, with fresh frozen plasma (FFP) being the most commonly used agent (86.5% patients, median dose 4 U). Vitamin K, activated factor VIIa and platelets were the other agents used. Post reversal, INR normalized within 24 h (median 1.2, IQR 1.1-1.3). There was no association between reversal and volume of hemorrhage, IVE, early mortality (death < 7 days) or functional outcome. Conclusions: Anticoagulated patients were at 1.7 times higher risk of early mortality after ICH. Reversal of INR to normal did not influence mortality or functional outcome.

AB - Objectives: To assess the impact of anticoagulants and antiplatelet agents on the severity and outcome of spontaneous non-traumatic intra-cerebral hemorrhage (ICH). To evaluate associations between reversal of anticoagulation and mortality/morbidity in these patients. Methods: Data was collected on a consecutive cohort of adults presenting with ICH to an academic Emergency Department over a 3-year period starting January 2006. Results: The final cohort of 245 patients consisted of 125 females (51.1%). The median age of the cohort was 73 years [inter-quartile (IQR) range of 59-82 years]. Antiplatelet (AP) use was seen in 32.6%, 18.4% were using anticoagulant (AC) and 8.9% patients were on both drugs (AC + AP). Patients on AC had significantly higher INR (median 2.3) and aPTT (median 31 s) when compared to patients not on AP/AC (median INR 1.0, median aPTT 24 s; p < 0.001). Similarly patients on AC + AP also had higher INR (median 1.9) and aPTT (median 30 s) when compared to those not on AC/AP (p < 0.001). Hemorrhage volumes were significantly higher for patients on AC alone (median 64.7 cm3) when compared to those not on either AC/AP (median 27.2 cm3; p = 0.05). The same was not found for patients using AP (median volume 20.5 cm3; p = 0.813), or both AC + AP (median volume 27.7 cm3; p = 0.619). Patients on AC were 1.43 times higher at risk to have intra-ventricular extension of hemorrhage (IVE) as compared to patients not on AC/AP (95% CI 1.04-1.98; p = 0.035). There was no relationship between the use of AC/AP/AC + AP and functional outcome of patients. Patients on AC were 1.74 times more likely to die within 7 days (95% CI 1.0-3.03; p = 0.05). No relationship was found between use of AP or AC + AP use and mortality. Of the 82 patients with INR > 1.0, 52 patients were given reversal (minimum INR 1.4, median 2.3). Therapy was heterogeneous, with fresh frozen plasma (FFP) being the most commonly used agent (86.5% patients, median dose 4 U). Vitamin K, activated factor VIIa and platelets were the other agents used. Post reversal, INR normalized within 24 h (median 1.2, IQR 1.1-1.3). There was no association between reversal and volume of hemorrhage, IVE, early mortality (death < 7 days) or functional outcome. Conclusions: Anticoagulated patients were at 1.7 times higher risk of early mortality after ICH. Reversal of INR to normal did not influence mortality or functional outcome.

KW - Anticoagulants

KW - Cerebral hemorrhage

KW - Platelet aggregation inhibitors

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