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Optimal timing of resumption of warfarin after intracranial hemorrhage
Department of Hematology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
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2010 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 41, no 12, 2860-2866 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2010. Vol. 41, no 12, 2860-2866 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-197773DOI: 10.1161/STROKEAHA.110.593087PubMedID: 21030703OAI: oai:DiVA.org:uu-197773DiVA: diva2:614096
Available from: 2013-04-03 Created: 2013-04-03 Last updated: 2017-12-06Bibliographically approved

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