Intracerebral hemorrhage in anticoagulated patients: What do we do afterwards?
Introduction: The management of antithrombotic therapy after intracerebral hemorrhage (ICH) in anticoagulated patients is not well defined. We analyzed the risks and benefits of antiplatelet therapy (AG) against the resumption of anticoagulation with vitamin K antagonists (AVK) in a series of patien...
| Authors: | ; ; ; ; ; |
|---|---|
| Format: | Article |
| Status: | Published version |
| Publication date: | 2012 |
| Country: | España |
| Institution: | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| Repository: | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| OAI Identifier: | oai:iibsantpau.fundanetsuite.com:p11441 |
| Online Access: | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=11441 |
| Access Level: | Open access |
| Keyword: | Cerebral hemorrhage Anticoagulation Vitamin K antagonists Antiplatelet treatment |
| _version_ | 1878739093027815424 |
|---|---|
| author | Vidal-Jordanaa, A |
| author2 | Barroeta-Espar, I Pelayo, MPS Mateo, J Delgado-Mederos, R Marti-Fabregas, J |
| author2_role | author author author author author |
| author_browse | Barroeta-Espar, I Delgado-Mederos, R Marti-Fabregas, J Mateo, J Pelayo, MPS Vidal-Jordanaa, A |
| author_facet | Vidal-Jordanaa, A Barroeta-Espar, I Pelayo, MPS Mateo, J Delgado-Mederos, R Marti-Fabregas, J |
| author_role | author |
| collection | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| description | Introduction: The management of antithrombotic therapy after intracerebral hemorrhage (ICH) in anticoagulated patients is not well defined. We analyzed the risks and benefits of antiplatelet therapy (AG) against the resumption of anticoagulation with vitamin K antagonists (AVK) in a series of patients. Material and methods: Retrospective study of ICH in anticoagulated patients. We registered demographic data, history of hypertension (HT), time of follow-up and new cerebral vascular events (ICH, stroke [IC]). Results: We evaluated 88 patients, mean age 69 +/- 9 years, 50% men, 73% hypertensive. During the acute phase 18 patients died and the follow-up was lost in 31. Of the remaining (n = 39), AVKs were resumed in 25 and changed to AG in 14. Comparing the characteristics of both groups, the anticoagulated group was younger (P = .005) and the embolic sources were more often of higher risk (P = .003). After an average follow-up of 54 +/- 31 months, the distribution of events was: IC (AVKs 8%, AG 14.3%, P = .6), ICH (AVKs 24%, AG 7.1%, P = .38), IC or ICH (AVKs 32%, AG 21.4%, P = .48) and death (AVKs 29%, AG 7.1%, P = .21). This trend of increased risk of new events in patients with AVKs was confirmed by Kaplan-Meier curves, although without statistical differences. Conclusions: Restarting AVK treatment after ICH in anticoagulated patients could increase the risk of new bleeding events and mortality. Prospective studies are needed to define a better and appropriate antithrombotic therapy after ICH related with anticoagulation. (C) 2011 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L. All rights reserved. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | ES_baeef5e7f3cd38eaa99ba9eb5fa65257 |
| institution | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| instname_str | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| network_acronym_str | ES |
| network_name_str | España |
| oai_identifier_str | oai:iibsantpau.fundanetsuite.com:p11441 |
| publishDate | 2012 |
| publishDateSort | 2012 |
| publisher | ELSEVIER ESPANA SLU |
| publisherStr | ELSEVIER ESPANA SLU |
| reponame_str | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| spelling | Intracerebral hemorrhage in anticoagulated patients: What do we do afterwards? Vidal-Jordanaa, A Barroeta-Espar, I Pelayo, MPS Mateo, J Delgado-Mederos, R Marti-Fabregas, J Cerebral hemorrhage Anticoagulation Vitamin K antagonists Antiplatelet treatment Introduction: The management of antithrombotic therapy after intracerebral hemorrhage (ICH) in anticoagulated patients is not well defined. We analyzed the risks and benefits of antiplatelet therapy (AG) against the resumption of anticoagulation with vitamin K antagonists (AVK) in a series of patients. Material and methods: Retrospective study of ICH in anticoagulated patients. We registered demographic data, history of hypertension (HT), time of follow-up and new cerebral vascular events (ICH, stroke [IC]). Results: We evaluated 88 patients, mean age 69 +/- 9 years, 50% men, 73% hypertensive. During the acute phase 18 patients died and the follow-up was lost in 31. Of the remaining (n = 39), AVKs were resumed in 25 and changed to AG in 14. Comparing the characteristics of both groups, the anticoagulated group was younger (P = .005) and the embolic sources were more often of higher risk (P = .003). After an average follow-up of 54 +/- 31 months, the distribution of events was: IC (AVKs 8%, AG 14.3%, P = .6), ICH (AVKs 24%, AG 7.1%, P = .38), IC or ICH (AVKs 32%, AG 21.4%, P = .48) and death (AVKs 29%, AG 7.1%, P = .21). This trend of increased risk of new events in patients with AVKs was confirmed by Kaplan-Meier curves, although without statistical differences. Conclusions: Restarting AVK treatment after ICH in anticoagulated patients could increase the risk of new bleeding events and mortality. Prospective studies are needed to define a better and appropriate antithrombotic therapy after ICH related with anticoagulation. (C) 2011 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L. All rights reserved. ELSEVIER ESPANA SLU https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=11441 |
| spellingShingle | Intracerebral hemorrhage in anticoagulated patients: What do we do afterwards? Vidal-Jordanaa, A Cerebral hemorrhage Anticoagulation Vitamin K antagonists Antiplatelet treatment |
| status_str | publishedVersion |
| title | Intracerebral hemorrhage in anticoagulated patients: What do we do afterwards? |
| title_full | Intracerebral hemorrhage in anticoagulated patients: What do we do afterwards? |
| title_fullStr | Intracerebral hemorrhage in anticoagulated patients: What do we do afterwards? |
| title_full_unstemmed | Intracerebral hemorrhage in anticoagulated patients: What do we do afterwards? |
| title_short | Intracerebral hemorrhage in anticoagulated patients: What do we do afterwards? |
| title_sort | Intracerebral hemorrhage in anticoagulated patients: What do we do afterwards? |
| topic | Cerebral hemorrhage Anticoagulation Vitamin K antagonists Antiplatelet treatment |
| topic_facet | Cerebral hemorrhage Anticoagulation Vitamin K antagonists Antiplatelet treatment |
| url | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=11441 |