Anticoagulant Related Intracerebral Hemorrhage

• Antiplatelet Use Prior to Anticoagulant Initiation in Patients With Atrial Fibrillation-Related Ischemic Stroke: An ELAN Trial Analysis
• A patient with patent foramen ovale associated ischemic stroke combined with hemorrhagic transformation: A case report
• Oral Anticoagulation following intracranial haemorrhage in patients with atrial fibrillation
• Reversal of anticoagulation in patients with intracerebral haemorrhage related to oral anticoagulants: State of the evidence
• Principles of reversal of anticoagulation in patients with intracerebral hemorrhage related to oral anticoagulants
• Residual Risk of Recurrent Stroke Despite Anticoagulation in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis
• Cerebral Venous Sinus Thrombosis Mimicking Tumor Hemorrhage: Successful Anticoagulation in a Resource-Limited Setting
• International Care Bundle Evaluation in Cerebral Hemorrhage Research (I-CATCHER): Study protocol for a multicenter, batched, parallel, cluster-randomized trial with a baseline period

see also Intracranial hemorrhage and anticoagulation.

Intracerebral hemorrhage risk is increased with higher doses than the recommended 100 mg of alteplase (Activase®, recombinant tissue plasminogen activator (rt-PA)) ¹⁾ in older patients, in those with anterior MI or higher Killip class, and with bolus administration (vs. infusion) ²⁾.

When heparin was used adjunctively, higher doses were associated with a higher risk of ICH ³⁾ ICH is thought to occur in those patients with some preexisting underlying vascular abnormality ⁴⁾. Immediate coronary angioplasty is safer than rt-PA when available ⁵⁾.

Affects up to 1% of patients on oral anticoagulation per year, and is the most feared and devastating complication of this treatment.

Patients with hemorrhage in a lobe or cerebral amyloid angiopathy remain at higher risk for anticoagulant-related intracerebral hemorrhage (ICH) recurrence than thromboembolic events and, therefore would be best managed without anticoagulants.

Anticoagulant Related Intracerebral Hemorrhage Diagnosis.

see Anticoagulant Related Intracerebral Hemorrhage Management.

Anticoagulant Related Intracerebral Hemorrhage Outcome

Intracerebral hemorrhage (ICH) is a life-threatening emergency, the incidence of which has increased in part due to an increase in the use of oral anticoagulants. A blood-fluid level within the hematoma, as revealed by computed tomography (CT), has been suggested as a marker for oral anticoagulant-associated ICH (OAC-ICH), but the diagnostic specificity and prognostic value of this finding remain unclear. In 855 patients with CT-confirmed acute ICH scanned within 48 h of symptom onset, Almarzouki et al. investigated the sensitivity and specificity of the presence of a CT-defined blood-fluid level (rated blinded to anticoagulant status) for identifying concomitant anticoagulant use. They also investigated the association of the presence of a blood-fluid level with six-month case fatality. Eighteen patients (2.1%) had a blood-fluid level identified on CT; of those with a blood-fluid level, 15 (83.3%) were taking anticoagulants. The specificity of the blood-fluid level for OAC-ICH was 99.4%; the sensitivity was 4.2%. We could not detect an association between the presence of a blood-fluid level and an increased risk of death at six months (OR = 1.21, 95% CI 0.28-3.88, p = 0.769). The presence of a blood-fluid level should alert clinicians to the possibility of OAC-ICH, but the absence of a blood-fluid level is not useful in excluding OAC-ICH ⁶⁾.