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Elevated International Normalized Ratio Is Associated With Ruptured Aneurysms.

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Elevated international normalized ratio (INR) values increase the risk of intracranial aneurysm rupture, especially in non-anticoagulated patients. Warfarin use may moderate this risk in anticoagulated individuals.

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aneurysmanticoagulantsinternational normalized ratiosubarachnoid hemorrhagewarfarin

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Area of Science:

  • Neurology
  • Vascular Surgery
  • Pharmacology

Background:

  • The relationship between anticoagulation, elevated international normalized ratio (INR), and aneurysmal subarachnoid hemorrhage risk is not well understood.
  • Intracranial aneurysms pose a significant risk of rupture, leading to subarachnoid hemorrhage.

Purpose of the Study:

  • To investigate the association between anticoagulation therapy, elevated INR values, and the rupture of intracranial aneurysms.
  • To determine how warfarin use and INR levels interact in influencing aneurysm rupture risk.

Main Methods:

  • A case-control study involving 4696 patients with 6403 intracranial aneurysms.
  • Analysis of patients on warfarin for anticoagulation versus those not on therapy.
  • Logistic regression and inverse probability weighting to assess the impact of INR and anticoagulation on rupture risk.

Main Results:

  • Elevated INR values were significantly associated with aneurysm rupture in non-anticoagulated patients.
  • Warfarin use interacted with INR (≥1.2), mitigating the effect of INR on rupture risk in anticoagulated patients.
  • Odds ratios indicated a substantial increase in rupture risk with elevated INR in the absence of anticoagulation.

Conclusions:

  • INR elevation is a significant risk factor for intracranial aneurysm rupture.
  • Warfarin therapy can modify the impact of INR on aneurysm rupture risk.
  • INR monitoring is crucial for managing patients with intracranial aneurysms, considering their anticoagulation status.