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[Intracranial hemorrhage in patients undergoing anticoagulant treatment with acenocoumarol]
J Elcano1, J M Martínez, J Foncuberta
1Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona.
Insights
Acenocoumarol anticoagulant therapy led to a 1.54% incidence of intracranial hemorrhage (ICH), with a 45% mortality rate. Risk factors included age over 65, hypertension, and prior stroke.
Area of Science:
- Clinical Medicine
- Neurology
- Cardiology
Context:
- A cohort of 2,012 patients receiving acenocoumarol between 1980 and 1985 was analyzed.
- Anticoagulant therapy is crucial for managing conditions like cardiac valvular disease but carries bleeding risks.
Purpose:
- To determine the incidence, characteristics, and mortality of intracranial hemorrhage (ICH) in patients treated with acenocoumarol.
- To identify potential risk factors and patient demographics associated with ICH during anticoagulant therapy.
Summary:
- 31 patients (1.54% incidence) experienced ICH, with a high mortality rate of 45%.
- Intraparenchymal hemorrhage was the most common type, often occurring after one year of therapy.
- Key risk factors identified included age over 65 (3x higher incidence), pre-existing hypertension (32%), and previous stroke (26%). Most patients were within the therapeutic anticoagulant range at the time of ICH.
Impact:
- Highlights the significant risk of ICH associated with acenocoumarol, emphasizing the need for careful patient monitoring.
- Findings underscore the importance of considering patient history (age, hypertension, stroke) when prescribing long-term anticoagulation.
- Demonstrates a correlation between hematoma size on CT scans and patient outcomes, aiding in prognosis.
Abstract:
Between 1980 and 1985, 2,012 patients treated with acenocoumarol were followed up. 31 of them had intracranial hemorrhage (ICH), representing an incidence of 1.54%. Its mortality rate was as high as 45%. The most common indication of anticoagulant therapy was cardiac valvular disease. No precipitating factors or concomitant hemorrhages in other sites were detected. Most patients with ICH were, at the time of the accident, within the therapeutic anticoagulant range. The most common localization of ICH was intraparenchymal; most of them developed after one year of anticoagulant therapy. In 32% of instances there was previous hypertension and previous stroke in 26%. ICH had a three times greater incidence in patients over 65 years. The patients who died showed larger hematomas than survivors in computed tomography.