[Cerebral haemorrhage in patients treated with oral anticoagulation]. / Hemorragia cerebral en pacientes en tratamiento con anticoagulantes orales.

INTRODUCTION: Intracranial haemorrhage (ICH) during dicumarinic treatment is a complication related to anticoagulation intensity with a high level of mortality. The aim of our study is to analize etiology, location and outcome of intracerebral haemorrhages related with anticoagulant therapy. PATIENTS AND METHODS: Over 401 spontaneous intracranial haemorrhages consecutively admitted in the neurological ward, we analyzed the acenocumarol ICH by location, anticoagulation range and factors that conditioned the outcome. RESULTS: We identified 26 patients, 6.5% of total ICH. Mean age was 75.2 +/- 7.9 years-old, over the rest of ICH. International Normalized Ratio (INR) was less than 2 in 10 patients, between 2 and 3 in six and greater than 3 in ten patients. 8 patients (31%) died, three of them had multiple ICH, but none of them had a INR greater than 2. Dicumarinic haemorrhages were of lobar location in 14 cases (three of them multiples) and deep in 12 cases. CONCLUSIONS: In our study, dicumarinic ICH are responsible of 6.5% total intracranial haemorrhages and they are not in clear relation with excessive anticoagulation. Mortality is slightly greater than the other ICH. Relatively benignity of these patients, the age and lobar location suggest that the etiology of these haemorrhages can be related to a subjacent amyloid angiopathy.

Hemorragia cerebral en pacientes en tratamiento con anticoagulantes orales / Cerebral haemorrhage in patients treated with oral anticoagulation

Introducción. Se considera que la hemorragia cerebral (HIC) en pacientes en tratamiento con dicumarínicos (acenocumarol) es una complicación relacionada con el grado de anticoagulación y que comporta una alta mortalidad. El objetivo del estudio es analizar la etiopatogenia, topografía y pronóstico de las HIC por anticoagulantes orales. Pacientes y métodos. Sobre 401 HIC espontáneas ingresadas consecutivamente en nuestra unidad se han analizado las HIC en pacientes en tratamiento con acenocumarol en cuanto a localización, intervalo de anticoagulación y factores que condicionan el pronóstico. Resultados. Se han identificado 26 pacientes, un 6,5% del total de HIC. La edad media fue de 75,2 ± 7,9 años, superior al resto de HIC. El INR (International Normalized Ratio) fue inferior a 2 en 10 pacientes, entre 2-3 en seis y mayor de 3 en 10. Ocho pacientes (31%) fallecieron, tres presentaban HIC múltiples, pero ninguno tenía un INR superior a 2. Las HIC por dicumarínicos fueron lobares en 14 casos (en tres múltiples) y profundas en 12 casos. Conclusiones. En nuestro estudio las HIC por acenocumarol fueron responsables del 6,5% del total de HIC y no se relacionaron claramente con una anticoagulación excesiva. La mortalidad de las HIC por anticoagulantes orales es levemente superior al del resto de las HIC. La relativa benignidad de estos pacientes, junto con la edad y la localización lobar, sugieren que la etiología de estas hemorragias pueda estar relacionada con una angiopatía amiloide cerebral subyacente

Introduction. Intracranial haemorrhage (ICH) during dicumarinic treatment is a complication related to anticoagulation intensity with a high level of mortality. The aim of our study is to analize etiology, location and outcome of intracerebral haemorrhages related with anticoagulant therapy. Patients and methods. Over 401 spontaneous intracranial haemorrhages consecutively admitted in the neurological ward, we analyzed the acenocumarol ICH by location, anticoagulation range and factors that conditioned the outcome. Results. We identified 26 patients, 6.5% of total ICH. Mean age was 75.2 ±7.9 years-old, over the rest of ICH. International Normalized Ratio (INR) was less than 2 in 10 patients, between 2 and 3 in six and greater than 3 in ten patients. 8 patients (31%) died, three of them had multiple ICH, but none of them had a INR greater than 2. Dicumarinic haemorrhages were of lobar location in 14 cases (three of them multiples) and deep in 12 cases. Conclusions. In our study, dicumarinic ICH are responsible of 6.5% total intracranial haemorrhages and they are not in clear relation with excessive anticoagulation. Mortality is slightly greater than the other ICH. Relatively benignity of these patients, the age and lobar location suggest that the etiology of these haemorrhages can be related to a subjacent amyloid angiopathy