What question did this study set out to answer?

To determine the optimal timing for resuming warfarin anticoagulation in patients who suffered a warfarin-related intracranial hemorrhage and have an ongoing indication for anticoagulation.

October 29, 2010StrokeOpen Access

Optimal Timing of Resumption of Warfarin After Intracranial Hemorrhage

Q: What does this research mean for the field?

Resuming warfarin therapy between 10 and 30 weeks after a warfarin-related intracranial hemorrhage minimizes the combined risk of recurrent intracranial hemorrhage and ischemic stroke. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Why the study?

Does the resumption of warfarin therapy optimize the combined risk of recurrent intracranial hemorrhage or ischemic stroke in patients who survived a warfarin-related intracranial hemorrhage?

Key Points

To determine the optimal timing for resuming warfarin anticoagulation in patients who suffered a warfarin-related intracranial hemorrhage and have an ongoing indication for anticoagulation.
Retrospective cohort study across 3 tertiary centers evaluating 2,869 consecutive patients with verified intracranial hemorrhage over a 6-year period.
Analyzed 177 patients with warfarin-associated intracranial hemorrhage who survived the first week, had cardiac indications or prior stroke, and had follow-up data (median follow-up 69 weeks [IQR 19–144]).
Calculated daily risk and applied a Cox model to determine hazard ratios for recurrent intracranial hemorrhage and ischemic stroke across various warfarin resumption intervals.
Warfarin resumption was associated with an increased hazard of recurrent intracranial hemorrhage (HR 5.6; 95% CI, 1.8–17.2) and a decreased hazard of ischemic stroke (HR 0.11; 95% CI, 0.014–0.89).
Among 59 patients who resumed warfarin at a median of 5.6 weeks (IQR 2.6–17), the combined risk of recurrent hemorrhage and ischemic stroke reached a nadir between 10 and 30 weeks post-event.

Structured PICO

Does the resumption of warfarin therapy optimize the combined risk of recurrent intracranial hemorrhage or ischemic stroke in patients who survived a warfarin-related intracranial hemorrhage?

Population

177 patients who survived the first week after warfarin-associated intracranial hemorrhage, had follow-up information available, and had a cardiac indication for anticoagulation or previous stroke.

Intervention

Resumption of warfarin therapy (resumed in 59 patients after a median of 5.6 weeks)

Comparator

No resumption of warfarin therapy

Outcome

Combined risk of either a new intracranial hemorrhage or an ischemic strokecomposite

Resuming warfarin between 10 and 30 weeks after a warfarin-related intracranial hemorrhage appears to optimally balance the risks of recurrent hemorrhage and ischemic stroke.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

May support 10-30 week resumption timing after warfarin ICH; hypothesis-generating and requires RCT confirmation.

Cite This Study

Majeed et al. (2010) studied this question.

synapsesocial.com/papers/6a1cd0e71fbf86d1e875c926 https://doi.org/10.1161/strokeaha.110.593087

Topics

Anticoagulation in AF

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Optimal Timing of Resumption of Warfarin After Intracranial Hemorrhage

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Optimal Timing of Resumption of Warfarin After Intracranial Hemorrhage

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider