INTRACRANIAL TRAUMATIC AND NONTRAUMATIC HEMORRHAGIC COMPLICATIONS OF WARFARIN TREATMENT

An increased referral of patients with anticoagulation related haemorr hages necessitated an analysis of causes and outcome of these complica tions in a patient group that reflected Swedish therapeutic traditions of anticoagulation treatment. Prospectively, all patients from Stockh olm evaluated for warfarin related intracranial haemorrhage occuring d uring 1987 were analysed and their 6 month outcome recorded. Sixty-eig ht patients were included. The results of intracranial haemorrhagic co mplications were catastrophic with a 77% mortality rate. Their inciden ce was much higher than expected. Forty-one patients had non-traumatic intracerebral haematomas, 1 had a non-traumatic subarachnoid haemorrh age and 26 had traumatic injuries, In the 42 patients with non-traumat ic haemorrhages, the indications for anticoagulation were cerebral isc haemic events in a majority (27/42). The remaining 15 patients had dif ferent indications for anticoagulation. They also had an increased fre quency of hypertension (p<0.05). In the 26 patients with traumatic hae matomas, only 6/26 patients had previous cerebral ischaemic injuries ( p<0.01). Valvular heart prothesis was their most common indication (11 /26) for anticoagulation. Caution in instituting anticoagulation thera py in patients with hypertension or cerebrovascular disease, which is an important indication for anticoagulation in Sweden, is mandatory. A dherence to strict treatment regimens and their continous reevaluation may help to avoid complications. The finding of more patients than ex pected with haemorrhagic complications is not compatible with the risk evaluations used to justify anticoagulation therapy in the patient gr oups studied. Clinical practice must have changed with time, showing t hat risk evaluations from controlled trials or retrospectively collect ed clinical data from selected patients are not necessarily applicable for long-term clinical practice.