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Vitamin K antagonists-associated cerebral hemorrhages: what are their characteristics?

Nelly Dequatre-Ponchelle1, Hilde Hénon, Marta Pasquini

  • 1Department of Neurology, University Lille Nord de France, UDSL, CHU Lille, EA 1046, F-59000 Lille, France.

Stroke
|January 5, 2013
PubMed

Insights

Vitamin K antagonists (VKAs) do not cause intracerebral hemorrhages (ICH) but impact their volume differently based on location. VKAs increase nonlobar ICH volume, suggesting varied vasculopathy susceptibility.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Pharmacology

Background:

  • Aging populations face increasing rates of intracerebral hemorrhages (ICH) linked to vitamin K antagonists (VKAs).
  • The precise role of VKAs as causes versus risk factors for ICH remains debated.
  • Understanding VKAs-ICH specificities is crucial for managing anticoagulation in elderly patients.

Purpose of the Study:

  • To investigate the specific characteristics of VKAs-associated intracerebral hemorrhages (VKAs-ICH).
  • To determine if VKAs act as causes or risk factors for ICH.
  • To explore the influence of VKAs on ICH volume based on anatomical location and underlying vasculopathy.

Main Methods:

  • Compared baseline characteristics of 545 spontaneous ICH patients, with and without VKA use.
  • Analyzed ICH characteristics, including volume, based on anatomical distribution (lobar vs. nonlobar).
  • Utilized multiple linear regression to assess the impact of VKAs on ICH volume, considering vasculopathy (cerebral amyloid angiopathy vs. deep perforating arteries).

Main Results:

  • VKAs-ICH constituted 15% of the cohort (83 patients).
  • VKA use did not alter the anatomical distribution of ICH.
  • VKAs significantly increased nonlobar ICH volume (25 mL vs. 12 mL, P=0.002) but not lobar ICH volume (26 mL vs. 30 mL, P=0.507).

Conclusions:

  • Similar ICH distribution in VKA users and non-users suggests VKAs are not direct causes of ICH.
  • Different impacts of VKAs on ICH volume by location indicate varying susceptibility of underlying vasculopathies.
  • Findings may inform tailored therapeutic strategies for VKA-associated ICH based on location and vasculopathy.
Abstract

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