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Arch Neurol. 2010 May;67(5):559-63. doi: 10.1001/archneurol.2010.25. Epub 2010 Mar 8.

Symptomatic intracerebral hemorrhage among eligible warfarin-treated patients receiving intravenous tissue plasminogen activator for acute ischemic stroke.

Author information

  • 1Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois 60612, USA. shyam_prabhakaran@rush.edu

Abstract

OBJECTIVE:

To determine whether warfarin-treated patients with an international normalized ratio less than 1.7 who receive intravenous tissue plasminogen activator for acute ischemic stroke are at increased risk for symptomatic intracerebral hemorrhage.

DESIGN:

Retrospective study.

SETTING:

Academic hospital.

PATIENTS:

Consecutive patients with acute ischemic stroke who are treated with intravenous tissue plasminogen activator.

MAIN OUTCOME MEASURE:

Symptomatic intracerebral hemorrhage.

RESULTS:

One hundred seven patients were included (mean age, 69.2 years; 43.9% men; median National Institutes of Health Stroke Scale score, 14; median onset-to-treatment time, 140 minutes; baseline warfarin use, 12.1%). The median international normalized ratio was 1.04 (range, 0.82-1.61). The overall rate of symptomatic intracerebral hemorrhage was 6.5%, but it was nearly 10-fold higher among patients taking warfarin compared with those not taking warfarin at baseline (30.8% vs 3.2%, respectively; P = .004). Baseline warfarin use remained strongly associated with symptomatic intracerebral hemorrhage (P = .004) after adjusting for relevant covariates, including age, atrial fibrillation, National Institutes of Health Stroke Scale score, and international normalized ratio.

CONCLUSIONS:

Despite an international normalized ratio less than 1.7, warfarin-treated patients are more likely than those not taking warfarin to experience symptomatic intracerebral hemorrhage following treatment with intravenous tissue plasminogen activator. Larger studies in this subgroup are warranted.

PMID:
20212195
[PubMed - indexed for MEDLINE]
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