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...

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Autores: Vidal-Jordanaa, A, Barroeta-Espar, I, Pelayo, MPS, Mateo, J, Delgado-Mederos, R, Marti-Fabregas, J
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2012
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p11441
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=11441
Access Level:acceso abierto
Palabra clave:Cerebral hemorrhage
Anticoagulation
Vitamin K antagonists
Antiplatelet treatment
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spelling Intracerebral hemorrhage in anticoagulated patients: What do we do afterwards?Vidal-Jordanaa, ABarroeta-Espar, IPelayo, MPSMateo, JDelgado-Mederos, RMarti-Fabregas, JCerebral hemorrhageAnticoagulationVitamin K antagonistsAntiplatelet treatmentIntroduction: 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 SLU2012info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=11441NEUROLOGIAISSN: 02134853ISSNe: 15781968reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Españolinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p114412026-06-14T12:41:47Z
dc.title.none.fl_str_mv Intracerebral hemorrhage in anticoagulated patients: What do we do afterwards?
title Intracerebral hemorrhage in anticoagulated patients: What do we do afterwards?
spellingShingle Intracerebral hemorrhage in anticoagulated patients: What do we do afterwards?
Vidal-Jordanaa, A
Cerebral hemorrhage
Anticoagulation
Vitamin K antagonists
Antiplatelet treatment
title_short 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_sort Intracerebral hemorrhage in anticoagulated patients: What do we do afterwards?
dc.creator.none.fl_str_mv Vidal-Jordanaa, A
Barroeta-Espar, I
Pelayo, MPS
Mateo, J
Delgado-Mederos, R
Marti-Fabregas, J
author Vidal-Jordanaa, A
author_facet Vidal-Jordanaa, A
Barroeta-Espar, I
Pelayo, MPS
Mateo, J
Delgado-Mederos, R
Marti-Fabregas, J
author_role author
author2 Barroeta-Espar, I
Pelayo, MPS
Mateo, J
Delgado-Mederos, R
Marti-Fabregas, J
author2_role author
author
author
author
author
dc.subject.none.fl_str_mv Cerebral hemorrhage
Anticoagulation
Vitamin K antagonists
Antiplatelet treatment
topic Cerebral hemorrhage
Anticoagulation
Vitamin K antagonists
Antiplatelet treatment
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.
publishDate 2012
dc.date.none.fl_str_mv 2012
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=11441
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=11441
dc.language.none.fl_str_mv Español
language_invalid_str_mv Español
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv ELSEVIER ESPANA SLU
publisher.none.fl_str_mv ELSEVIER ESPANA SLU
dc.source.none.fl_str_mv NEUROLOGIA
ISSN: 02134853
ISSNe: 15781968
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
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repository.mail.fl_str_mv
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