Restarting anticoagulation therapy after warfarin-associated intracerebral hemorrhage
Restarting anticoagulation therapy after warfarin-associated intracerebral hemorrhage
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DOI：
10.1001/archneur.65.10.1313
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发表时间：
2008-10-01
影响因子：
--
通讯作者：
Rabinstein, Alejandro A.
中科院分区：
文献类型：
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作者：
Claassen, Daniel O.;Kazemi, Noojan;Rabinstein, Alejandro A.
背景资料：对近期发生华法林相关脑出血（WAICH）的患者重新开始华法林钠治疗是一个困难的临床决定。因此，评估WAICH后华法林治疗的恢复或中止的结果是很重要的。目的：比较WAICH发作后存活并重新开始华法林治疗的患者与一组未重新开始华法林治疗的WAICH患者。设计、设置和患者：我们从2001年11月1日至2005年12月31日在一个单中心的队列中进行了一项随访研究。在最后的临床随访或通过questionnaire.Main Outcome Measures：复发WAICH和血栓栓塞events.Results：52例患者出院后WAICH的诊断。4例患者失访。所有患者的平均随访时间为43个月（范围：1-108）。在23例重新开始华法林治疗的患者中，1例复发性非创伤性WAICH，2例创伤性脑内出血，2例严重颅外出血。在25例未重新开始华法林治疗的患者中，3例发生血栓栓塞性卒中，1例发生肺栓塞，1例发生远端动脉栓塞。结论：近期WAICH患者重新开始华法林治疗与复发风险低相关，但患者受到已知的华法林使用的重大风险的影响。停止华法林治疗与血栓栓塞风险相关。
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. Longterm 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.