Poor Prognosis in Warfarin-Associated Intracranial Hemorrhage Despite Anticoagulation Reversal
Poor Prognosis in Warfarin-Associated Intracranial Hemorrhage Despite Anticoagulation Reversal
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DOI：
10.1161/strokeaha.112.652065
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发表时间：
2012-07-01
期刊：
影响因子：
8.3
通讯作者：
Coutts, Shelagh B.
中科院分区：
文献类型：
--
作者：
Dowlatshahi, Dar;Butcher, Kenneth S.;Coutts, Shelagh B.
背景和目的——抗凝相关性颅内出血（aaICH）比自发性颅内出血具有更大的血肿体积、更高的血肿扩张风险以及更差的结果。凝血酶原复合物浓缩物 (PCC) 适用于 aaICH 后紧急逆转抗凝治疗。鉴于缺乏疗效的随机对照试验证据以及血栓并发症的可能性，我们旨在确定接受 PCC 治疗的 aaICH 患者的结局。方法 - 我们对加拿大接受 PCC 治疗的 aaICH 患者进行了前瞻性多中心登记。 PCC 释放后，当地血库对患者进行了鉴定。图表审查提取了临床、影像和实验室数据，包括治疗后的血栓事件。通过脑部 CT 扫描测量血肿量，主要结果是出院时改良 Rankin 量表和院内死亡率。结果 - 2008 年至 2010 年间，141 名患者因 aaICH 接受 PCC（71 例脑实质内出血）。中位年龄为 78 岁（四分位距，14），59.6% 为男性，格拉斯哥昏迷量表中位为 14。中位国际标准化比率为 2.6（四分位距，2.0），中位实质血肿量为 15.8 mL（四分位距，31.8）。 PCC 治疗后国际标准化比率中位数为 1.4：79.5% 的患者进行了国际标准化比率校正（
Background and Purpose-Anticoagulant-associated intracranial hemorrhage (aaICH) presents with larger hematoma volumes, higher risk of hematoma expansion, and worse outcome than spontaneous intracranial hemorrhage. Prothrombin complex concentrates (PCCs) are indicated for urgent reversal of anticoagulation after aaICH. Given the lack of randomized controlled trial evidence of efficacy, and the potential for thrombotic complications, we aimed to determine outcomes in patients with aaICH treated with PCC.Methods-We conducted a prospective multicenter registry of patients treated with PCC for aaICH in Canada. Patients were identified by local blood banks after the release of PCC. A chart review abstracted clinical, imaging, and laboratory data, including thrombotic events after therapy. Hematoma volumes were measured on brain CT scans and primary outcomes were modified Rankin Scale at discharge and in-hospital mortality.Results-Between 2008 and 2010, 141 patients received PCC for aaICH (71 intraparenchymal hemorrhages). The median age was 78 years (interquartile range, 14), 59.6% were male, and median Glasgow Coma Scale was 14. Median international normalized ratio was 2.6 (interquartile range, 2.0) and median parenchymal hematoma volume was 15.8 mL (interquartile range, 31.8). Median post-PCC therapy international normalized ratio was 1.4: 79.5% of patients had international normalized ratio correction (