MANAGEMENT OF INTRACRANIAL HEMORRHAGE ASSOCIATED WITH ANTICOAGULANT-THERAPY

BACKGROUND Intracranial hemorrhage may be a particularly devastating c omplication of anticoagulant therapy, Very few accounts have reported data on the duration of anticoagulant discontinuation following intrac ranial hemorrhage or the intensity of anticoagulation during treatment for it, although we must adequately manage such a complication. METHO DS We analyzed the management of warfarin-related intracranial hemorrh ages in 27 patients with cardiac diseases. We evaluated the degree of anticoagulation using the thrombotest. Anticoagulants were stopped as soon as the diagnosis of intracranial hemorrhage was established by co mputed tomographic scan. RESULTS Mechanical valve prosthesis patients, who required intensive long-term anticoagulant therapy, constituted t he majority of our series (74.1%). Intraoperative hemostasis was broug ht under control despite low thrombotest values (13%-68%) at the time of surgery except for the acute subdural hematoma (SDH) patients with cerebral contusion. Early resumption of anticoagulant therapy (within 3 days) did not cause intracranial rebleeding in any operative patient . All the chronic SDH patients and some of the subcortical hematoma pa tients had a good outcome. All three patients with acute SDH and contu sion, however, had a fatal outcome because of intracranial rebleeding within a short period of time or ineffective intraoperative hemostasis . CONCLUSIONS The patients with anticoagulant-related intracranial hem orrhage may undergo surgery with thrombotest values approximately betw een 20% and 60%, and anticoagulants can be resumed after an interval o f 3 days. Aggressive surgery should particularly be performed in patie nts with anticoagulation-related chronic SDH or subcortical hemorrhage , as in the cases of anticoagulant-unrelated intracranial hemorrhage.