J Korean Neurosurg Soc.  2014 Feb;55(2):69-72. 10.3340/jkns.2014.55.2.69.

Effect of Discontinuation of Anticoagulation in Patients with Intracranial Hemorrhage at High Thromboembolic Risk

• Jung HS
• Jeon IC
• Chang CH
• Jung YJ

• KMID: 2191047
• DOI: http://doi.org/10.3340/jkns.2014.55.2.69

Abstract

OBJECTIVE
There was no abundance of data on the use of anticoagulant in patients with previous high risk of thromboembolic conditions under a newly developed intracranial hemorrhage in Korean society. The purpose of this study was to evaluate the safety of discontinuance and suggest the proper time period for discontinuance of anticoagulant among these patients.
METHODS
We reviewed the medical records of 19 patients who took anticoagulant because of thromboembolic problems and were admitted to our department with newly developed anticoagulation associated intracranial hemorrhage (AAICH), and stopped taking medicine due to concern of rebleeding from January 2008 to December 2012. Analysis of the incidence of thromboembolic complications and proper withdrawal time of anticoagulant was performed using the Kaplan-Meier method.
RESULTS
Our patients showed high risk for thromboembolic complication. The CHA2DS2-VASc score ranged from two to five. Thromboembolic complication occurred in eight (42.1%) out of 19 patients without restarting anticoagulant since the initial hemorrhage. Among them, three patients (37.5%) died from direct thromboembolic complications. Mean time to outbreak of thromboembolic complication was 21.38+/-14.89 days (range, 8-56 days). The probability of thromboembolic complications at 7, 14, and 30 days since cessation of anticoagulation was 0.00, 10.53, and 38.49%, respectively.
CONCLUSION
Short term discontinuance of anticoagulant within seven days in patients with AAICH who are at high embolic risk (CHA2DS2-VASc score >2) appears to be relatively safe in Korean people. However, prolonged cessation (more than seven days) may result in increased incidence of catastrophic thromboembolic complications.

Keyword

Anticoagulation; Intracerebral hemorrhage; Thromboembolic complication

MeSH Terms

Cerebral Hemorrhage
Hemorrhage
Humans
Incidence
Intracranial Hemorrhages*
Medical Records
Methods

Figure

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  Fig. 1 Kaplan-Meier thromboembolic complication free survival estimate for patients with anticoagulants associated intracranial hemorrhage without resuming anticoagulants. The probability of thromboembolic complications after cessation of anticoagulation at 7, 14, and 30 days was 0.00, 10.53, and 38.49%, respectively.

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