Subtherapeutic International Normalized Ratio in Warfarin-Treated Patients Increases the Risk for Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis
2011; Lippincott Williams & Wilkins; Volume: 42; Issue: 8 Linguagem: Inglês
10.1161/strokeaha.111.614214
ISSN1524-4628
AutoresRaymond C.S. Seet, Yi Zhang, S. Arthur Moore, Eelco F. M. Wijdicks, Alejandro A. Rabinstein,
Tópico(s)Venous Thromboembolism Diagnosis and Management
ResumoThere is uncertainty whether warfarin-treated patients (despite international normalized ratio < 1.7) have increased risks of symptomatic intracerebral hemorrhage after intravenous thrombolysis.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.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.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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