Anticoagulant Reversal, Blood Pressure Levels, and Anticoagulant Resumption in Patients With Anticoagulation-Related Intracerebral Hemorrhage

作者：Joji B. Kuramatsu, Stefan T. Gerner, Peter D. Schellinger, Jörg Glahn, Matthias Endres, Jan Sobesky, Julia Flechsenhar, Hermann Neugebauer, Eric Jüttler, Armin Grau, Frederick Palm, Joachim Röther, Peter Michels, Gerhard F. Hamann, J. Hüwel, Georg Hagemann, Beatrice Barber, Christoph Terborg, Frank Trostdorf, Hansjörg Bäzner, Aletta Roth, Johannes C. Wöhrle, Moritz Keller, Michael Schwarz, Gernot Reimann, Jens Volkmann, Wolfgang Müllges, Peter Kraft, Joseph Claßen, Carsten Hobohm, Markus Horn, Angelika Milewski, Heinz Reichmann, Hauke Schneider, Eik Schimmel, Gereon R. Fink, Christian Dohmen, Henning Stetefeld, Otto W. Witte, Albrecht Günther, Tobias Neumann‐Haefelin, Andras E. Racs, Martin Nueckel, Frank Erbguth, Stephan Kloska, Arnd Dörfler, Martin Köhrmann, Stefan Schwab, Hagen B. Huttner · 发表于：JAMA · 年份：2015 · DOI：10.1001/jama.2015.0846 · 被引用次数：567 · 研究领域：Intracerebral and Subarachnoid Hemorrhage Research、Atrial Fibrillation Management and Outcomes、Spinal Hematomas and Complications

IMPORTANCE: Although use of oral anticoagulants (OACs) is increasing, there is a substantial lack of data on how to treat OAC-associated intracerebral hemorrhage (ICH). OBJECTIVE: To assess the association of anticoagulation reversal and blood pressure (BP) with hematoma enlargement and the effects of OAC resumption. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study at 19 German tertiary care centers (2006-2012) including 1176 individuals for analysis of long-term functional outcome, 853 for analysis of hematoma enlargement, and 719 for analysis of OAC resumption. EXPOSURES: Reversal of anticoagulation during acute phase, systolic BP at 4 hours, and reinitiation of OAC for long-term treatment. MAIN OUTCOMES AND MEASURES: Frequency of hematoma enlargement in relation to international normalized ratio (INR) and BP. Incidence analysis of ischemic and hemorrhagic events with or without OAC resumption. Factors associated with favorable (modified Rankin Scale score, 0-3) vs unfavorable functional outcome. RESULTS: Hemorrhage enlargement occurred in 307 of 853 patients (36.0%). Reduced rates of hematoma enlargement were associated with reversal of INR levels <1.3 within 4 hours after admission (43/217 [19.8%]) vs INR of ≥1.3 (264/636 [41.5%]; P < .001) and systolic BP <160 mm Hg at 4 hours (167/504 [33.1%]) vs ≥160 mm Hg (98/187 [52.4%]; P < .001). The combination of INR reversal <1.3 within 4 hours and systolic BP of <160 mm Hg at 4 hours was associated with lower rates...