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@ARTICLE{Kuramatsu:255985,
      author       = {Kuramatsu, Joji B. and Gerner, Stefan T. and Schellinger,
                      Peter D. and Glahn, Jörg and Endres, Matthias and Sobesky,
                      Jan and Flechsenhar, Julia and Neugebauer, Hermann and
                      Jüttler, Eric and Grau, Armin and Palm, Frederick and
                      Röther, Joachim and Michels, Peter and Hamann, Gerhard F.
                      and Hüwel, Joachim and Hagemann, Georg and Barber, Beatrice
                      and Terborg, Christoph and Trostdorf, Frank and Bäzner,
                      Hansjörg and Roth, Aletta and Wöhrle, Johannes and Keller,
                      Moritz and Schwarz, Michael and Reimann, Gernot and
                      Volkmann, Jens and Müllges, Wolfgang and Kraft, Peter and
                      Classen, Joseph and Hobohm, Carsten and Horn, Markus and
                      Milewski, Angelika and Reichmann, Heinz and Schneider, Hauke
                      and Schimmel, Eik and Fink, Gereon R. and Dohmen, Christian
                      and Stetefeld, Henning and Witte, Otto and Günther,
                      Albrecht and Neumann-Haefelin, Tobias and Racs, Andras E.
                      and Nueckel, Martin and Erbguth, Frank and Kloska, Stephan
                      P. and Dörfler, Arnd and Köhrmann, Martin and Schwab,
                      Stefan and Huttner, Hagen B.},
      title        = {{A}nticoagulant {R}eversal, {B}lood {P}ressure {L}evels,
                      and {A}nticoagulant {R}esumption in {P}atients {W}ith
                      {A}nticoagulation-{R}elated {I}ntracerebral {H}emorrhage},
      journal      = {The journal of the American Medical Association},
      volume       = {313},
      number       = {8},
      issn         = {0098-7484},
      address      = {Chicago, Ill.},
      publisher    = {American Medical Association},
      reportid     = {FZJ-2015-06043},
      pages        = {824 - 836},
      year         = {2015},
      abstract     = {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.},
      cin          = {INM-3},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-3-20090406},
      pnm          = {572 - (Dys-)function and Plasticity (POF3-572)},
      pid          = {G:(DE-HGF)POF3-572},
      typ          = {PUB:(DE-HGF)16},
      UT           = {WOS:000349826400016},
      pubmed       = {pmid:25710659},
      doi          = {10.1001/jama.2015.0846},
      url          = {https://juser.fz-juelich.de/record/255985},
}