Key result
Prior warfarin treatment with subtherapeutic INR significantly increased the risk of symptomatic intracerebral hemorrhage after intravenous thrombolysis (adjusted OR 14.7; 95% CI 1.3-54.3).
Why the study?
Does prior warfarin use with subtherapeutic INR increase the risk of symptomatic intracerebral hemorrhage in acute stroke patients undergoing intravenous thrombolysis?
Cohort (n=212)
Does prior warfarin use with subtherapeutic INR increase the risk of symptomatic intracerebral hemorrhage in acute stroke patients undergoing intravenous thrombolysis?
Odds Ratio: 14.7 (95% CI 1.3–54.3)
Prior warfarin use, even with a subtherapeutic INR (<1.7), is associated with a substantially increased risk of symptomatic intracerebral hemorrhage following intravenous thrombolysis for acute stroke.
Caution warranted before thrombolysis in warfarin patients with INR <1.7; leaves open whether sICH risk is increased.
BACKGROUND AND PURPOSE: There is uncertainty whether warfarin-treated patients (despite international normalized ratio < 1.7) have increased risks of symptomatic intracerebral hemorrhage after intravenous thrombolysis. METHODS: Vascular risk factors, stroke subtype, and outcome measures were compared between warfarin- and nonwarfarin-treated patients undergoing acute thrombolysis within 3 hours of symptom onset. RESULTS: From 212 patients (mean age, 74 ± 14 years; 50% men) studied, 14 (6.5%) had prior warfarin use. After adjusting for age, baseline National Institutes of Health Stroke Scale, and stroke subtype, warfarin-treated patients had significantly increased risks of developing symptomatic intracerebral hemorrhage (adjusted OR, 14.7; 95% CI, 1.3 to 54.3). A trend for poorer stroke recovery and increased mortality was observed in warfarin-treated patients on univariate, but not on multivariable, analyses. CONCLUSIONS: Warfarin-treated patients with stroke have increased risks of symptomatic intracerebral hemorrhage after thrombolytic treatment. These data raise safety concerns of thrombolytic treatment in warfarin-treated patients with subtherapeutic international normalized ratio.
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Seet et al. (2011) conducted a cohort in Acute stroke (n=212). Warfarin treatment (subtherapeutic INR) vs. Nonwarfarin treatment was evaluated on Symptomatic intracerebral hemorrhage (adjusted OR 14.7, 95% CI 1.3 to 54.3). Prior warfarin treatment with subtherapeutic INR significantly increased the risk of symptomatic intracerebral hemorrhage after intravenous thrombolysis (adjusted OR 14.7; 95% CI 1.3-54.3).
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