Warfarin associated intracerebral haemorrhage in Hong Kong

Abstract

OBJECTIVE: To study the clinical features and factors that predict clinical outcome of Chinese patients with warfarin-associated intracerebral hemorrhage (WICH). BACKGROUND: WICH is a serious neurological condition associated with significant mortality and morbidity. Data of WICH in Chinese is lacking seriously. DESIGN/METHODS: Medical records of patients with WICH admitted to our hospital from July 2001 till June 2010 were reviewed. Good outcome was defined as modified Rankin Scale (mRS) 0-3 and poor outcome was defined as mRS 4-6. RESULTS: 51 patients with WICH were identified. The mean age was 74.3±10.5 years. The mean INR on presentation was 2.9±1.0. The median ICH volume was 23.3(10.4-59.3) ml. The mortality rate at 30 day and 3-6 months were 58.0% and 62.0% respectively. Multivariate logistic analysis revealed that an initial ICH volume of >20ml (OR 34.4; 95% confidence interval (CI): 1.2-956.8, p=0.037) and presence of intraventricular hemorrhage (OR 22.9; 95% CI:1.1-494.2, p=0.046) were independently associated with poor outcome. Supratherapeutic INR (INR >3.0) (p=0.724) and complete correction of INR within 24 hours after admission (p=0.486) were not independent predictors of poor outcome. The median ICH volumes did not differ between INR groups (18.2(9.4 - 61.1) ml for INR≤3 vs. 27.3(13.7 - 58.5) ml for INR>3, p=0.718). Neurological deterioration was documented in 19 (63.3%) of the 30 patients included in a smaller sub-cohort, and was associated with poor neurological outcome (OR 20.7; 95% CI:1.5-284.4, p=0.027). Warfarin was resumed in 7 of the 20 survivors. There were 2 episodes of recurrent WICH and 1 episode of ischemic stroke during a mean follow-up duration of 5.4 years. In survivors who were not resumed on warfarin, there were 2 episodes of recurrent ICH and 12 episodes of ischemic vascular events during a mean follow-up duration of 2.6 years. CONCLUSIONS: WICH is a serious complication of warfarin therapy with high mortality and morbidity. Initial ICH volume, presence of intraventricular hemorrhage and neurological deterioration are independent predictors of clinical outcome.