A study has found that among patients with oral anti-coagulation-associated intra-cerebral haemorrhage (bleeding within the brain), reversal of international normalised ratio below a certain level within 4 hours and systolic blood pressure less than 160 mm Hg at 4 hours were associated with lower rates of haematoma enlargement, and resumption of anticoagulant therapy was associated with a lower risk of ischaemic events without increased bleeding complications.
The prevalence of cardiovascular diseases requiring long-term oral anti-coagulation (OAC) is increasing. The most significant complication of OAC is intra-cerebral haemorrhage (ICH). Among all types of stroke, there is a substantial lack of data about how to manage OAC-ICH. Two of the most pressing unsettled questions are how to prevent haematoma enlargement and how to manage anti-coagulation in the long-term. Consensus exists that elevated INR levels should be reversed to minimise haematoma enlargement, yet mode of reversal, timing, and extent of INR reversal are unclear. Valid data on safety and clinical benefit of OAC resumption are missing and remain to be established, according to background information in the article.
Dr Hagen B Huttner, of the University of Erlangen-Nuremberg, Erlangen, Germany, and colleagues conducted a study to assess the association of anti-coagulation reversal and blood pressure (BP) with haematoma enlargement and the effects of OAC resumption. The study, conducted at 19 German tertiary care centres (2006-2012), included 1,176 individuals for analysis of long-term functional outcome, 853 for analysis of hematoma enlargement, and 719 for analysis of OAC resumption.
Haemorrhage enlargement occurred in 307 of 853 patients (36.0%). Reduced rates of haematoma enlargement were associated with reversal of INR levels
"The study represents the largest cohort of patients with OAC-ICH to date and reports 2 clinically valuable associations. First, rates of hematoma enlargement were decreased in patients with INR values reversed below 1.3 within 4 hours of admission and systolic blood pressures of less than 160 mm Hg at 4 hours. Second, rates of ischemic events were decreased among patients who restarted OAC without increased rates of bleeding complications," the authors write.
"These retrospective findings require replication and assessment in prospective studies."
[link url="http://media.jamanetwork.com/news-item/findings-may-help-with-the-management-of-anticoagulant-related-bleeding-within-the-brain/"]JAMA material[/link]
[link url="http://jama.jamanetwork.com/article.aspx?articleid=2130316"]JAMA abstract[/link]