Optimal Timing of Resumption of Warfarin After Intracranial Hemorrhage
- Authors
- Majeed, Ammar; Kim, Yang-Ki; Roberts, Robin S.; Holmstrom, Margareta; Schulman, Sam
- Issue Date
- Dec-2010
- Publisher
- Lippincott Williams & Wilkins Ltd.
- Keywords
- intracranial hemorrhage; anticoagulation; ischemic stroke; management
- Citation
- Stroke, v.41, no.12, pp 2860 - 2866
- Pages
- 7
- Journal Title
- Stroke
- Volume
- 41
- Number
- 12
- Start Page
- 2860
- End Page
- 2866
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/17471
- DOI
- 10.1161/STROKEAHA.110.593087
- ISSN
- 0039-2499
1524-4628
- Abstract
- Background and Purpose-The optimum timing of resumption of anticoagulation after warfarin-related intracranial hemorrhage in patients with indication for continued anticoagulation is uncertain. We performed a large retrospective cohort study to obtain more precise risk estimates. Methods-We reviewed charts of 2869 consecutive patients with objectively verified intracranial hemorrhage over 6 years at 3 tertiary centers. We calculated the daily risk of intracranial hemorrhage or ischemic stroke with and without resumption of warfarin; we focused on patients who survived the first week and had cardiac indication for anticoagulation or previous stroke. Using a Cox model, we estimated rates for these 2 adverse events in relation to different time points of resumed anticoagulation. The combined risk of either a new intracranial hemorrhage or an ischemic stroke was calculated for a range of warfarin resumption times. Results-We identified warfarin-associated intracranial hemorrhage in 234 patients (8.2%), of whom 177 patients (76%) survived the first week and had follow-up information available; the median follow-up time was 69 weeks (interquartile range [IQR] 19-144). Fifty-nine patients resumed warfarin after a median of 5.6 weeks (IQR 2.6-17). The hazard ratio for recurrent intracranial hemorrhage with resumption of warfarin was 5.6 (95% CI, 1.8-17.2), and for ischemic stroke it was 0.11 (95% CI, 0.014-0.89). The combined risk of recurrent intracranial hemorrhage or ischemic stroke reached a nadir if warfarin was resumed after approximately 10 to 30 weeks. Conclusion-The optimal timing for resumption of warfarin therapy appears to be between 10 and 30 weeks after warfarin-related intracranial hemorrhage. (Stroke. 2010;41:2860-2866.)
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