Key result
Discontinuation of anticoagulation in patients with anticoagulation-associated intracranial hemorrhage at high thromboembolic risk resulted in a 42.1% rate of thromboembolic complications, with no events within 7 days but a 38.5% probability at 30 days.
Why the study?
Does the duration of anticoagulant discontinuation affect the incidence of thromboembolic complications in patients with anticoagulation-associated intracranial hemorrhage?
Cohort (n=19)
No
Does the duration of anticoagulant discontinuation affect the incidence of thromboembolic complications in patients with anticoagulation-associated intracranial hemorrhage?
In patients with anticoagulation-associated intracranial hemorrhage at high thromboembolic risk, discontinuing anticoagulation for up to 7 days appears safe, but longer cessation significantly increases thromboembolic risk.
Short-term pause up to 7 days may be feasible; hypothesis-generating from case report and requires prospective confirmation before practice change.
OBJECTIVE: There was no abundance of data on the use of anticoagulant in patients with previous high risk of thromboembolic conditions under a newly developed intracranial hemorrhage in Korean society. The purpose of this study was to evaluate the safety of discontinuance and suggest the proper time period for discontinuance of anticoagulant among these patients. METHODS: We reviewed the medical records of 19 patients who took anticoagulant because of thromboembolic problems and were admitted to our department with newly developed anticoagulation associated intracranial hemorrhage (AAICH), and stopped taking medicine due to concern of rebleeding from January 2008 to December 2012. Analysis of the incidence of thromboembolic complications and proper withdrawal time of anticoagulant was performed using the Kaplan-Meier method. RESULTS: Our patients showed high risk for thromboembolic complication. The CHA2DS2-VASc score ranged from two to five. Thromboembolic complication occurred in eight (42.1%) out of 19 patients without restarting anticoagulant since the initial hemorrhage. Among them, three patients (37.5%) died from direct thromboembolic complications. Mean time to outbreak of thromboembolic complication was 21.38±14.89 days (range, 8-56 days). The probability of thromboembolic complications at 7, 14, and 30 days since cessation of anticoagulation was 0.00, 10.53, and 38.49%, respectively. CONCLUSION: Short term discontinuance of anticoagulant within seven days in patients with AAICH who are at high embolic risk (CHA2DS2-VASc score >2) appears to be relatively safe in Korean people. However, prolonged cessation (more than seven days) may result in increased incidence of catastrophic thromboembolic complications.
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Jung et al. (2014) conducted a cohort in Anticoagulation-associated intracranial hemorrhage (n=19). Discontinuation of anticoagulation was evaluated on Thromboembolic complications. Discontinuation of anticoagulation in patients with anticoagulation-associated intracranial hemorrhage at high thromboembolic risk resulted in a 42.1% rate of thromboembolic complications, with no events within 7 days but a 38.5% probability at 30 days.
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