TY  - JOUR
AU  - Kuramatsu, Joji B.
AU  - Gerner, Stefan T.
AU  - Schellinger, Peter D.
AU  - Glahn, Jörg
AU  - Endres, Matthias
AU  - Sobesky, Jan
AU  - Flechsenhar, Julia
AU  - Neugebauer, Hermann
AU  - Jüttler, Eric
AU  - Grau, Armin
AU  - Palm, Frederick
AU  - Röther, Joachim
AU  - Michels, Peter
AU  - Hamann, Gerhard F.
AU  - Hüwel, Joachim
AU  - Hagemann, Georg
AU  - Barber, Beatrice
AU  - Terborg, Christoph
AU  - Trostdorf, Frank
AU  - Bäzner, Hansjörg
AU  - Roth, Aletta
AU  - Wöhrle, Johannes
AU  - Keller, Moritz
AU  - Schwarz, Michael
AU  - Reimann, Gernot
AU  - Volkmann, Jens
AU  - Müllges, Wolfgang
AU  - Kraft, Peter
AU  - Classen, Joseph
AU  - Hobohm, Carsten
AU  - Horn, Markus
AU  - Milewski, Angelika
AU  - Reichmann, Heinz
AU  - Schneider, Hauke
AU  - Schimmel, Eik
AU  - Fink, Gereon R.
AU  - Dohmen, Christian
AU  - Stetefeld, Henning
AU  - Witte, Otto
AU  - Günther, Albrecht
AU  - Neumann-Haefelin, Tobias
AU  - Racs, Andras E.
AU  - Nueckel, Martin
AU  - Erbguth, Frank
AU  - Kloska, Stephan P.
AU  - Dörfler, Arnd
AU  - Köhrmann, Martin
AU  - Schwab, Stefan
AU  - Huttner, Hagen B.
TI  - Anticoagulant Reversal, Blood Pressure Levels, and Anticoagulant Resumption in Patients With Anticoagulation-Related Intracerebral Hemorrhage
JO  - The journal of the American Medical Association
VL  - 313
IS  - 8
SN  - 0098-7484
CY  - Chicago, Ill.
PB  - American Medical Association
M1  - FZJ-2015-06043
SP  - 824 - 836
PY  - 2015
AB  - Importance Although use of oral anticoagulants (OACs) is increasing, there is a substantial lack of data on how to treat OAC-associated intracerebral hemorrhage (ICH).Objective  To assess the association of anticoagulation reversal and blood pressure (BP) with hematoma enlargement and the effects of OAC resumption.Design, Setting, and Participants  Retrospective cohort study at 19 German tertiary care centers (2006-2012) including 1176 individuals for analysis of long-term functional outcome, 853 for analysis of hematoma enlargement, and 719 for analysis of OAC resumption.Exposures  Reversal of anticoagulation during acute phase, systolic BP at 4 hours, and reinitiation of OAC for long-term treatment.Main Outcomes and Measures  Frequency of hematoma enlargement in relation to international normalized ratio (INR) and BP. Incidence analysis of ischemic and hemorrhagic events with or without OAC resumption. Factors associated with favorable (modified Rankin Scale score, 0-3) vs unfavorable functional outcome.Results  Hemorrhage enlargement occurred in 307 of 853 patients (36.0%). Reduced rates of hematoma enlargement were associated with reversal of INR levels <1.3 within 4 hours after admission (43/217 [19.8%]) vs INR of ≥1.3 (264/636 [41.5%]; P < .001) and systolic BP <160 mm Hg at 4 hours (167/504 [33.1%]) vs ≥160 mm Hg (98/187 [52.4%]; P < .001). The combination of INR reversal <1.3 within 4 hours and systolic BP of <160 mm Hg at 4 hours was associated with lower rates of hematoma enlargement (35/193 [18.1%] vs 220/498 [44.2%] not achieving these values; OR, 0.28; 95% CI, 0.19-0.42; P < .001) and lower rates of in-hospital mortality (26/193 [13.5%] vs 103/498 [20.7%]; OR, 0.60; 95% CI, 0.37-0.95; P = .03). OAC was resumed in 172 of 719 survivors (23.9%). OAC resumption showed fewer ischemic complications (OAC: 9/172 [5.2%] vs no OAC: 82/547 [15.0%]; P < .001) and not significantly different hemorrhagic complications (OAC: 14/172 [8.1%] vs no OAC: 36/547 [6.6%]; P = .48). Propensity-matched survival analysis in patients with atrial fibrillation who restarted OAC showed a decreased HR of 0.258 (95% CI, 0.125-0.534; P < .001) for long-term mortality. Functional long-term outcome was unfavorable in 786 of 1083 patients (72.6%).Conclusions and Relevance  Among patients with OAC-associated ICH, reversal of INR <1.3 within 4 hours and systolic BP <160 mm Hg at 4 hours were associated with lower rates of hematoma enlargement, and resumption of OAC therapy was associated with lower risk of ischemic events. These findings require replication and assessment in prospective studies.
LB  - PUB:(DE-HGF)16
UR  - <Go to ISI:>//WOS:000349826400016
C6  - pmid:25710659
DO  - DOI:10.1001/jama.2015.0846
UR  - https://juser.fz-juelich.de/record/255985
ER  -