A multicenter, prospective, observational study of warfarin-associated intracerebral hemorrhage: The SAMURAI-WAICH study

Masato Osaki, Masatoshi Koga, Koichiro Maeda, Yasuhiro Hasegawa, Jyoji Nakagawara, Eisuke Furui, Kenichi Todo, Kazumi Kimura, Yoshiaki Shiokawa, Yasushi Okada, Satoshi Okuda, Kazuomi Kario, Hiroshi Yamagami, Kazuo Minematsu, Takanari Kitazono, Kazunori Toyoda

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Abstract

Background Because patients with warfarin-associated intracerebral hemorrhage (WAICH) have a high risk of ongoing bleeding, disability, and death, urgent coagulopathy reversal should be considered. On the other hand, thromboembolism may occur with reversal or withholding of anticoagulant therapy. The current status of acute hemostatic treatments and clinical outcomes in WAICH patients was investigated. Methods WAICH patients admitted within 3 days of onset were prospectively enrolled in 10 stroke centers. Thromboembolic and hemorrhagic complications and functional outcomes were followed-up for one year. Results Of 50 WAICH patients (31 men, 73 ± 9 years old) enrolled, all stopped warfarin on admission. Elevated prothrombin time-international normalized ratios (PT-INR) were normalized in 43 (86%). Anticoagulant therapy was resumed with intravenous full-dose unfractionated heparin followed by warfarin in 9 (18%), intravenous low-dose unfractionated heparin followed by warfarin in 14 (28%) and warfarin alone in 14 (28%) at a median of 2.5 (IQR 1.25-9), 4 (2-5.5) and 6 (3-11) days after onset, respectively, after emergent admission. Onset-to-admission time (per 1-hour increase; OR 0.55, 95% CI 0.19-0.84) was inversely associated with hematoma expansion. Anticoagulant therapy was resumed with intravenous full-dose unfractionated heparin in 9 (18%), low-dose heparin in 14 (28%) and warfarin alone in 14 (28%) at a median of 2.5, 4 and 6 days after onset, respectively. During one-year follow-up (n = 47), 11 thromboembolic and 6 hemorrhagic complications were documented. Twenty four patients showed unfavorable outcomes, corresponding to a modified Rankin Scale score of 4-6. Thromboembolic complications (OR, 10.62; 95% CI, 1.05-227.85), as well as advanced age (per 1 year; OR, 1.27; 95% CI, 1.10-1.61) and higher National Institutes of Health Stroke Scale (NIHSS) score (per 1 point; OR, 1.24; 95% CI 1.07-1.55), were independently associated with unfavorable outcome. Conclusions PT-INR normalization on admission and early anticoagulant resumption were common in WAICH patients. Thromboembolic complications were independently associated with unfavorable outcome.

Original languageEnglish
Pages (from-to)72-77
Number of pages6
JournalJournal of the Neurological Sciences
Volume359
Issue number1-2
DOIs
Publication statusPublished - Dec 15 2015

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Cerebral Hemorrhage
Warfarin
Observational Studies
Prospective Studies
Anticoagulants
Heparin
International Normalized Ratio
Prothrombin Time
Stroke
Thromboembolism
National Institutes of Health (U.S.)
Hemostatics
Hematoma
Therapeutics
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

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A multicenter, prospective, observational study of warfarin-associated intracerebral hemorrhage : The SAMURAI-WAICH study. / Osaki, Masato; Koga, Masatoshi; Maeda, Koichiro; Hasegawa, Yasuhiro; Nakagawara, Jyoji; Furui, Eisuke; Todo, Kenichi; Kimura, Kazumi; Shiokawa, Yoshiaki; Okada, Yasushi; Okuda, Satoshi; Kario, Kazuomi; Yamagami, Hiroshi; Minematsu, Kazuo; Kitazono, Takanari; Toyoda, Kazunori.

In: Journal of the Neurological Sciences, Vol. 359, No. 1-2, 15.12.2015, p. 72-77.

Research output: Contribution to journalArticle

Osaki, M, Koga, M, Maeda, K, Hasegawa, Y, Nakagawara, J, Furui, E, Todo, K, Kimura, K, Shiokawa, Y, Okada, Y, Okuda, S, Kario, K, Yamagami, H, Minematsu, K, Kitazono, T & Toyoda, K 2015, 'A multicenter, prospective, observational study of warfarin-associated intracerebral hemorrhage: The SAMURAI-WAICH study', Journal of the Neurological Sciences, vol. 359, no. 1-2, pp. 72-77. https://doi.org/10.1016/j.jns.2015.10.031
Osaki, Masato ; Koga, Masatoshi ; Maeda, Koichiro ; Hasegawa, Yasuhiro ; Nakagawara, Jyoji ; Furui, Eisuke ; Todo, Kenichi ; Kimura, Kazumi ; Shiokawa, Yoshiaki ; Okada, Yasushi ; Okuda, Satoshi ; Kario, Kazuomi ; Yamagami, Hiroshi ; Minematsu, Kazuo ; Kitazono, Takanari ; Toyoda, Kazunori. / A multicenter, prospective, observational study of warfarin-associated intracerebral hemorrhage : The SAMURAI-WAICH study. In: Journal of the Neurological Sciences. 2015 ; Vol. 359, No. 1-2. pp. 72-77.
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abstract = "Background Because patients with warfarin-associated intracerebral hemorrhage (WAICH) have a high risk of ongoing bleeding, disability, and death, urgent coagulopathy reversal should be considered. On the other hand, thromboembolism may occur with reversal or withholding of anticoagulant therapy. The current status of acute hemostatic treatments and clinical outcomes in WAICH patients was investigated. Methods WAICH patients admitted within 3 days of onset were prospectively enrolled in 10 stroke centers. Thromboembolic and hemorrhagic complications and functional outcomes were followed-up for one year. Results Of 50 WAICH patients (31 men, 73 ± 9 years old) enrolled, all stopped warfarin on admission. Elevated prothrombin time-international normalized ratios (PT-INR) were normalized in 43 (86{\%}). Anticoagulant therapy was resumed with intravenous full-dose unfractionated heparin followed by warfarin in 9 (18{\%}), intravenous low-dose unfractionated heparin followed by warfarin in 14 (28{\%}) and warfarin alone in 14 (28{\%}) at a median of 2.5 (IQR 1.25-9), 4 (2-5.5) and 6 (3-11) days after onset, respectively, after emergent admission. Onset-to-admission time (per 1-hour increase; OR 0.55, 95{\%} CI 0.19-0.84) was inversely associated with hematoma expansion. Anticoagulant therapy was resumed with intravenous full-dose unfractionated heparin in 9 (18{\%}), low-dose heparin in 14 (28{\%}) and warfarin alone in 14 (28{\%}) at a median of 2.5, 4 and 6 days after onset, respectively. During one-year follow-up (n = 47), 11 thromboembolic and 6 hemorrhagic complications were documented. Twenty four patients showed unfavorable outcomes, corresponding to a modified Rankin Scale score of 4-6. Thromboembolic complications (OR, 10.62; 95{\%} CI, 1.05-227.85), as well as advanced age (per 1 year; OR, 1.27; 95{\%} CI, 1.10-1.61) and higher National Institutes of Health Stroke Scale (NIHSS) score (per 1 point; OR, 1.24; 95{\%} CI 1.07-1.55), were independently associated with unfavorable outcome. Conclusions PT-INR normalization on admission and early anticoagulant resumption were common in WAICH patients. Thromboembolic complications were independently associated with unfavorable outcome.",
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TY - JOUR

T1 - A multicenter, prospective, observational study of warfarin-associated intracerebral hemorrhage

T2 - The SAMURAI-WAICH study

AU - Osaki, Masato

AU - Koga, Masatoshi

AU - Maeda, Koichiro

AU - Hasegawa, Yasuhiro

AU - Nakagawara, Jyoji

AU - Furui, Eisuke

AU - Todo, Kenichi

AU - Kimura, Kazumi

AU - Shiokawa, Yoshiaki

AU - Okada, Yasushi

AU - Okuda, Satoshi

AU - Kario, Kazuomi

AU - Yamagami, Hiroshi

AU - Minematsu, Kazuo

AU - Kitazono, Takanari

AU - Toyoda, Kazunori

PY - 2015/12/15

Y1 - 2015/12/15

N2 - Background Because patients with warfarin-associated intracerebral hemorrhage (WAICH) have a high risk of ongoing bleeding, disability, and death, urgent coagulopathy reversal should be considered. On the other hand, thromboembolism may occur with reversal or withholding of anticoagulant therapy. The current status of acute hemostatic treatments and clinical outcomes in WAICH patients was investigated. Methods WAICH patients admitted within 3 days of onset were prospectively enrolled in 10 stroke centers. Thromboembolic and hemorrhagic complications and functional outcomes were followed-up for one year. Results Of 50 WAICH patients (31 men, 73 ± 9 years old) enrolled, all stopped warfarin on admission. Elevated prothrombin time-international normalized ratios (PT-INR) were normalized in 43 (86%). Anticoagulant therapy was resumed with intravenous full-dose unfractionated heparin followed by warfarin in 9 (18%), intravenous low-dose unfractionated heparin followed by warfarin in 14 (28%) and warfarin alone in 14 (28%) at a median of 2.5 (IQR 1.25-9), 4 (2-5.5) and 6 (3-11) days after onset, respectively, after emergent admission. Onset-to-admission time (per 1-hour increase; OR 0.55, 95% CI 0.19-0.84) was inversely associated with hematoma expansion. Anticoagulant therapy was resumed with intravenous full-dose unfractionated heparin in 9 (18%), low-dose heparin in 14 (28%) and warfarin alone in 14 (28%) at a median of 2.5, 4 and 6 days after onset, respectively. During one-year follow-up (n = 47), 11 thromboembolic and 6 hemorrhagic complications were documented. Twenty four patients showed unfavorable outcomes, corresponding to a modified Rankin Scale score of 4-6. Thromboembolic complications (OR, 10.62; 95% CI, 1.05-227.85), as well as advanced age (per 1 year; OR, 1.27; 95% CI, 1.10-1.61) and higher National Institutes of Health Stroke Scale (NIHSS) score (per 1 point; OR, 1.24; 95% CI 1.07-1.55), were independently associated with unfavorable outcome. Conclusions PT-INR normalization on admission and early anticoagulant resumption were common in WAICH patients. Thromboembolic complications were independently associated with unfavorable outcome.

AB - Background Because patients with warfarin-associated intracerebral hemorrhage (WAICH) have a high risk of ongoing bleeding, disability, and death, urgent coagulopathy reversal should be considered. On the other hand, thromboembolism may occur with reversal or withholding of anticoagulant therapy. The current status of acute hemostatic treatments and clinical outcomes in WAICH patients was investigated. Methods WAICH patients admitted within 3 days of onset were prospectively enrolled in 10 stroke centers. Thromboembolic and hemorrhagic complications and functional outcomes were followed-up for one year. Results Of 50 WAICH patients (31 men, 73 ± 9 years old) enrolled, all stopped warfarin on admission. Elevated prothrombin time-international normalized ratios (PT-INR) were normalized in 43 (86%). Anticoagulant therapy was resumed with intravenous full-dose unfractionated heparin followed by warfarin in 9 (18%), intravenous low-dose unfractionated heparin followed by warfarin in 14 (28%) and warfarin alone in 14 (28%) at a median of 2.5 (IQR 1.25-9), 4 (2-5.5) and 6 (3-11) days after onset, respectively, after emergent admission. Onset-to-admission time (per 1-hour increase; OR 0.55, 95% CI 0.19-0.84) was inversely associated with hematoma expansion. Anticoagulant therapy was resumed with intravenous full-dose unfractionated heparin in 9 (18%), low-dose heparin in 14 (28%) and warfarin alone in 14 (28%) at a median of 2.5, 4 and 6 days after onset, respectively. During one-year follow-up (n = 47), 11 thromboembolic and 6 hemorrhagic complications were documented. Twenty four patients showed unfavorable outcomes, corresponding to a modified Rankin Scale score of 4-6. Thromboembolic complications (OR, 10.62; 95% CI, 1.05-227.85), as well as advanced age (per 1 year; OR, 1.27; 95% CI, 1.10-1.61) and higher National Institutes of Health Stroke Scale (NIHSS) score (per 1 point; OR, 1.24; 95% CI 1.07-1.55), were independently associated with unfavorable outcome. Conclusions PT-INR normalization on admission and early anticoagulant resumption were common in WAICH patients. Thromboembolic complications were independently associated with unfavorable outcome.

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