Published Online
on August 14, 2008

A more recent version of this article appeared on November 1, 2008

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Submitted on March 18, 2008
Accepted on April 11, 2008

Hematoma Growth in Oral Anticoagulant Related Intracerebral Hemorrhage

Brett Cucchiara MD^*; Steven Messe MD; Lauren Sansing MD; Scott Kasner MD; Patrick Lyden MD; for the CHANT Investigators

From the Department of Neurology (B.C., S.M., L.S., S.K.), University of Pennsylvania Medical Center, Philadelphia; and the Department of Neurology (P.S.L.), University of California, San Diego.

^* To whom correspondence should be addressed. E-mail: cucchiar{at}mail.med.upenn.edu.

Background and Purpose—Limited data suggest that intracerebral hemorrhage related to oral anticoagulant therapy (OAT ICH) is associated with more hemorrhage expansion and a worse prognosis than spontaneous ICH (SICH).

Methods—We examined patients enrolled in the placebo arm of the CHANT study, a prospective randomized trial of a putative neuroprotectant in patients with ICH. All patients had neuroimaging within 6 hours of symptom onset and at 72 hours. Initial ICH volume and hemorrhage expansion were determined by a central reader. Multivariable logistic regression was used to determine factors associated with ICH expansion and mortality at 90 days.

Results—Of 303 patients included, 21 (6.9%) had OAT ICH. Baseline median ICH volume was greater in patients with OAT ICH compared to SICH (30.6 versus 14.4 mL, P=0.03). Hemorrhage expansion (defined as >33% increase in ICH volume) occurred in 56% of patients with OAT ICH compared to 26% of SICH (P=0.006). Mortality was substantially higher in OAT ICH (62% versus 17%, P<0.001). In multivariable analysis, time to neuroimaging and oral anticoagulant use were independently associated with hemorrhage expansion, and age, gender, and oral anticoagulant use were independently associated with mortality.

Conclusions—These findings confirm that OAT ICH is associated with more hemorrhage expansion and greater mortality than SICH.

Key words: warfarin • intracerebral hemorrhage • anticoagulation

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