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Warfarin Use Linked to Larger Intracerebral Hemorrhage

Intracerebral hemorrhage patients with international normalized ratio above 3.0 had larger hematoma volume

TUESDAY, Sept. 30 (HealthDay News) -- Patients with intracerebral hemorrhage who are using warfarin and have an international normalized ratio (INR) greater than 3.0 may be at risk of larger hemorrhage, according to research published in the Sept. 30 issue of Neurology.

Matthew L. Flaherty, M.D., of the University of Cincinnati Academic Health Center in Ohio, and colleagues analyzed data from 258 patients with intracerebral hemorrhage, mean age 68.5. Fifty-one of the patients were taking warfarin. The first available INR value upon presentation was noted, and hemorrhage volume was assessed from the first available brain scan.

Subjects with INR over 3.0 had greater hematoma volume compared with those with INR below 1.2, the researchers report. Other factors predicting larger hematoma size were lobar hemorrhage, compared with deep cerebral hemorrhage, and shorter time from the onset of stroke to the scan, the report indicates.

"Although hemostasis and anticoagulant reversal remain important targets to improve outcome among anticoagulant-associated intracerebral hemorrhage (AAICH) patients, our findings indicate that some of the excess mortality among AAICH patients will not be remediable by these strategies. In a recently published multivariable model of intracerebral hemorrhage outcome among 218 patients without coagulopathy, for each 1.0-mL increase in baseline hematoma volume, the hazard ratio for death increased by 1 percent. When modeling hematoma size in our population, patients with INR greater than 3.0 had initial hematoma volumes approximately 25 mL greater than those of patients without coagulopathy, enough to produce a potent effect on mortality in this group," the authors write.

Several of the study authors disclosed financial relationships with pharmaceutical companies.

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