Document Detail

Optimal timing of resumption of warfarin after intracranial hemorrhage.
MedLine Citation:
PMID:  21030703     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: The optimum timing of resumption of anticoagulation after warfarin-related intracranial hemorrhage in patients with indication for continued anticoagulation is uncertain. We performed a large retrospective cohort study to obtain more precise risk estimates.
METHODS: We reviewed charts of 2869 consecutive patients with objectively verified intracranial hemorrhage over 6 years at 3 tertiary centers. We calculated the daily risk of intracranial hemorrhage or ischemic stroke with and without resumption of warfarin; we focused on patients who survived the first week and had cardiac indication for anticoagulation or previous stroke. Using a Cox model, we estimated rates for these 2 adverse events in relation to different time points of resumed anticoagulation. The combined risk of either a new intracranial hemorrhage or an ischemic stroke was calculated for a range of warfarin resumption times.
RESULTS: We identified warfarin-associated intracranial hemorrhage in 234 patients (8.2%), of whom 177 patients (76%) survived the first week and had follow-up information available; the median follow-up time was 69 weeks (interquartile range [IQR] 19-144). Fifty-nine patients resumed warfarin after a median of 5.6 weeks (IQR 2.6-17). The hazard ratio for recurrent intracranial hemorrhage with resumption of warfarin was 5.6 (95% CI, 1.8-17.2), and for ischemic stroke it was 0.11 (95% CI, 0.014-0.89). The combined risk of recurrent intracranial hemorrhage or ischemic stroke reached a nadir if warfarin was resumed after approximately 10 to 30 weeks.
CONCLUSIONS: The optimal timing for resumption of warfarin therapy appears to be between 10 and 30 weeks after warfarin-related intracranial hemorrhage.
Ammar Majeed; Yang-Ki Kim; Robin S Roberts; Margareta Holmström; Sam Schulman
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2010-10-28
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  41     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-30     Completed Date:  2010-12-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2860-6     Citation Subset:  IM    
Department of Hematology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
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MeSH Terms
Aged, 80 and over
Anticoagulants / administration & dosage,  adverse effects*,  therapeutic use*
Brain Ischemia / epidemiology,  prevention & control
Cerebral Hemorrhage / chemically induced*
Cohort Studies
Fibrinolytic Agents / adverse effects,  therapeutic use
International Normalized Ratio
Middle Aged
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Stroke / epidemiology,  prevention & control
Time Factors
Warfarin / administration & dosage,  adverse effects*,  therapeutic use*
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents; 81-81-2/Warfarin

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