Abstract
Background: Reinitiating warfarin sodium therapy in a patient with a recent warfarin-related intracerebral hemorrhage (WAICH) is a difficult clinical decision. Therefore, it is important to assess the outcome of resumption or discontinuation of warfarin therapy after WAICH. Objective: To compare patients who survived an episode of WAICH and restarted warfarin therapy with a group of WAICH patients who did not resume warfarin therapy. Design, Setting, and Patients: We conducted a follow-up study from November 1, 2001, through December 31, 2005, in a cohort from a single center. Long-term outcome was assessed at last clinical follow-up or via questionnaire. Main Outcome Measures: Recurrent WAICH and thromboembolic events. Results: Fifty-two patients were discharged from the hospital after a diagnosis of WAICH. Four patients were lost to follow-up. Mean follow-up among all patients was 43 (range, 1-108) months. Of the 23 patients who restarted warfarin therapy, 1 had a recurrent nontraumatic WAICH, 2 had traumatic intracerebral hemorrhages, and 2 had major extracranial hemorrhages. Of the 25 patients who did not restart warfarin therapy, 3 had a thromboembolic stroke, 1 had a pulmonary embolus, and 1 had a distal arterial embolus. Conclusions: Restarting warfarin therapy in patients with a recent WAICH is associated with a low risk of recurrence, but patients are subjected to known, substantial risks of warfarin use. Withholding warfarin therapy is associated with a risk of thromboembolization.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1313-1318 |
| Number of pages | 6 |
| Journal | Archives of Neurology |
| Volume | 65 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 1 2008 |
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ASJC Scopus subject areas
- Arts and Humanities (miscellaneous)
- Clinical Neurology
Cite this
Restarting anticoagulation therapy after warfarin-associated intracerebral hemorrhage. / Claassen, Daniel O.; Kazemi, Noojan; Zubkov, Alexander Y.; Wijdicks, Eelco F.M.; Rabinstein, Alejandro.
In: Archives of Neurology, Vol. 65, No. 10, 01.10.2008, p. 1313-1318.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Restarting anticoagulation therapy after warfarin-associated intracerebral hemorrhage
AU - Claassen, Daniel O.
AU - Kazemi, Noojan
AU - Zubkov, Alexander Y.
AU - Wijdicks, Eelco F.M.
AU - Rabinstein, Alejandro
PY - 2008/10/1
Y1 - 2008/10/1
N2 - Background: Reinitiating warfarin sodium therapy in a patient with a recent warfarin-related intracerebral hemorrhage (WAICH) is a difficult clinical decision. Therefore, it is important to assess the outcome of resumption or discontinuation of warfarin therapy after WAICH. Objective: To compare patients who survived an episode of WAICH and restarted warfarin therapy with a group of WAICH patients who did not resume warfarin therapy. Design, Setting, and Patients: We conducted a follow-up study from November 1, 2001, through December 31, 2005, in a cohort from a single center. Long-term outcome was assessed at last clinical follow-up or via questionnaire. Main Outcome Measures: Recurrent WAICH and thromboembolic events. Results: Fifty-two patients were discharged from the hospital after a diagnosis of WAICH. Four patients were lost to follow-up. Mean follow-up among all patients was 43 (range, 1-108) months. Of the 23 patients who restarted warfarin therapy, 1 had a recurrent nontraumatic WAICH, 2 had traumatic intracerebral hemorrhages, and 2 had major extracranial hemorrhages. Of the 25 patients who did not restart warfarin therapy, 3 had a thromboembolic stroke, 1 had a pulmonary embolus, and 1 had a distal arterial embolus. Conclusions: Restarting warfarin therapy in patients with a recent WAICH is associated with a low risk of recurrence, but patients are subjected to known, substantial risks of warfarin use. Withholding warfarin therapy is associated with a risk of thromboembolization.
AB - Background: Reinitiating warfarin sodium therapy in a patient with a recent warfarin-related intracerebral hemorrhage (WAICH) is a difficult clinical decision. Therefore, it is important to assess the outcome of resumption or discontinuation of warfarin therapy after WAICH. Objective: To compare patients who survived an episode of WAICH and restarted warfarin therapy with a group of WAICH patients who did not resume warfarin therapy. Design, Setting, and Patients: We conducted a follow-up study from November 1, 2001, through December 31, 2005, in a cohort from a single center. Long-term outcome was assessed at last clinical follow-up or via questionnaire. Main Outcome Measures: Recurrent WAICH and thromboembolic events. Results: Fifty-two patients were discharged from the hospital after a diagnosis of WAICH. Four patients were lost to follow-up. Mean follow-up among all patients was 43 (range, 1-108) months. Of the 23 patients who restarted warfarin therapy, 1 had a recurrent nontraumatic WAICH, 2 had traumatic intracerebral hemorrhages, and 2 had major extracranial hemorrhages. Of the 25 patients who did not restart warfarin therapy, 3 had a thromboembolic stroke, 1 had a pulmonary embolus, and 1 had a distal arterial embolus. Conclusions: Restarting warfarin therapy in patients with a recent WAICH is associated with a low risk of recurrence, but patients are subjected to known, substantial risks of warfarin use. Withholding warfarin therapy is associated with a risk of thromboembolization.
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U2 - 10.1001/archneur.65.10.1313
DO - 10.1001/archneur.65.10.1313
M3 - Article
VL - 65
SP - 1313
EP - 1318
JO - Archives of Neurology
JF - Archives of Neurology
SN - 0003-9942
IS - 10
ER -