ANTICOAGULANT - RELATED INTRACEREBRAL HEM ORRHAGE

Cerebral haemorrhage is the main life-threatening complication of oral anticoagulant therapy. In order to identify a means of prevention, th e authors undertook a retrospective study of 68 consecutive cases of a nticoagulant-related intracerebral haemorrhage. The mortality was 38.5 %. The respective frequency of intracerebral haemorrhage, subarachnoid haemorrhage, acute and chronic subdural haematomas was 63.2, 16.2, 10 .3 and 10.3%, respectively. On admission, nearly half the patients (53 %) had prothrombin ratios inferior to 25 %. A predisposing factor was found in 58 % of cases : hypertension (30.6 %), head injury (14.5 %), alcoholism or drug interaction (11.2 %), and one case of intracerebral aneurysm. A history of a transient ischaemic attack or of a cerebrova scular accident was found in 10.2 % of cases and 11.7 % had a previous anticoagulant related extracranial haemorrhage. The initial indicatio ns for oral anticoagulation were ischaemic heart disease (32 %), atria l fibrillation (20.5 %), secondary prevention of venous thromboembolic disease (17.6%) and primary prevention of venous thrombosis (11.7%). The duration of treatment for isolated ischaemic heart disease was ove r 6 months in all cases: the average duration of treatment was 12.4 mo nths in phlebitis and pulmonary embolism. A critical review of the ind ications of treatment in the light of recent recommendations showed th at if inappropriate indications were rare, the sometimes unnecessary p rolongation of treatment was more common. Nearly half of these cases w ere receiving anticoagulants when the potential benefits were question able at the time of the haemorrhagic complication. Clinical and biolog ical follow-up is necessary for patients on anticoagulants; minor blee ding complications may be the prelude to major haemorrhage. Biological follow-up is based on control of the international normalised ratio. The benefit/risk ratio of anticoagulant therapy should be weighed up d uring treatment in order to limit haemorrhagic complications, especial ly intracranial bleeding; the number of haemorrhages increases with ti me in cumulated cases whereas the benefits of anticoagulant therapy de crease in certain indications.