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Higher baseline international normalized ratio value correlates with higher mortality in intracerebral hemorrhage during warfarin use
Author(s) -
Curtze S.,
Strbian D.,
Meretoja A.,
Putaala J.,
Eriksson H.,
Haapaniemi E.,
Mustanoja S.,
Sairanen T.,
Satopää J.,
Silvennoinen H.,
Niemelä M.,
Kaste M.,
Tatlisumak T.
Publication year - 2014
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12352
Subject(s) - medicine , intracerebral hemorrhage , logistic regression , odds ratio , confounding , warfarin , retrospective cohort study , stroke (engine) , cohort , atrial fibrillation , mechanical engineering , subarachnoid hemorrhage , engineering
Background and purpose Intracerebral hemorrhage ( ICH ) is the most feared complication of oral anticoagulation ( OAC ). Our aim was to investigate the impact of the international normalized ratio ( INR ) level on mortality in OAC ‐associated ICH compared with non‐ OAC ‐associated ICH . Methods A retrospective chart review of consecutive ICH patients treated at the Helsinki University Central Hospital from January 2005 to March 2010 ( n = 1013) was performed. An ICH was considered to be OAC ‐associated if the patient was on warfarin at ICH onset. The association of INR with 3‐month mortality was adjusted in a multivariable logistic regression model for factors influencing the crude odds ratios (ORs) in bivariable logistic regression by more than 5%. Results One in eight ICHs was OAC‐associated ( n = 132). Of these, 50% had therapeutic INR (2.0–3.0), 7% had INR <2.0 and 43% had high INR (>3.0) on admission. Patients on OAC were older (median 76 vs. 66 years; P < 0.001) with more severe symptoms (median National Institutes of Health Stroke Scale 14 vs. 10; P < 0.001) and larger hematomas (median 11.4 vs. 9.7 ml; P < 0.001) on admission than patients not on OAC. After adjustment for confounders, 3‐month mortality in the whole cohort was associated with higher baseline INR (OR 1.06; CI 1.03–1.09 per 0.1 increment). Mortality was higher with both therapeutic (51% at 3 months; OR 3.59; CI 1.50–8.60) and high (61%; OR 5.26; CI 1.94–14.27) INR values compared with non‐OAC‐associated ICH (29%). Conclusions Patients with OAC ‐associated ICH had more severe strokes and higher mortality compared with patients with ICH not related to OAC . Higher baseline INR was associated with increased 3‐month mortality.