Rapid INR reversal key in oral anticoagulant–associated intracerebral hemorrhage

Rapid reversal of international normalized ratio, along with systolic blood pressure reduction, in patients with oral anticoagulant–associated intracerebral hemorrhage can significantly reduce the rates of hematoma enlargement and in-hospital mortality, a retrospective cohort study has found.

In the German study of 1,176 patients with oral anticoagulant–associated intracerebral hemorrhage, patients whose INR was reduced below 1.3 with use of vitamin K agonists and whose systolic BP was reduced below 160 mm Hg within 4 hours of admission had a 72% reduction in the rates of hematoma enlargement and 40% reduction in in-hospital mortality, compared with patients who did not achieve those reductions in that time frame.

Researchers also showed that there were no significant increases in hemorrhagic complications, but fewer ischemic complications, among patients who resumed oral anticoagulation, according to the study published online Feb. 24 in JAMA.

“Consensus exists that elevated international normalized ratio (INR) levels should be reversed to minimize hematoma enlargement, yet mode, timing, and extent of INR reversal are unclear [and] valid data on safety and clinical benefit of [oral anticoagulant] resumption are missing and remain to be established,” wrote Dr. Joji B. Kuramatsu of the University of Erlangen-Nuremberg, Germany, and coauthors (JAMA 2015;313:824-836 [doi:10.1001/jama.2015.0846]).

The study was supported by the Johannes and Frieda Marohn Foundation. Authors declared a range of funding, grants, fees, and honoraria from the pharmaceutical industry.

Rapid reversal of international normalized ratio, along with systolic blood pressure reduction, in patients with oral anticoagulant–associated intracerebral hemorrhage can significantly reduce the rates of hematoma enlargement and in-hospital mortality, a retrospective cohort study has found.

In the German study of 1,176 patients with oral anticoagulant–associated intracerebral hemorrhage, patients whose INR was reduced below 1.3 with use of vitamin K agonists and whose systolic BP was reduced below 160 mm Hg within 4 hours of admission had a 72% reduction in the rates of hematoma enlargement and 40% reduction in in-hospital mortality, compared with patients who did not achieve those reductions in that time frame.

Researchers also showed that there were no significant increases in hemorrhagic complications, but fewer ischemic complications, among patients who resumed oral anticoagulation, according to the study published online Feb. 24 in JAMA.

“Consensus exists that elevated international normalized ratio (INR) levels should be reversed to minimize hematoma enlargement, yet mode, timing, and extent of INR reversal are unclear [and] valid data on safety and clinical benefit of [oral anticoagulant] resumption are missing and remain to be established,” wrote Dr. Joji B. Kuramatsu of the University of Erlangen-Nuremberg, Germany, and coauthors (JAMA 2015;313:824-836 [doi:10.1001/jama.2015.0846]).

The study was supported by the Johannes and Frieda Marohn Foundation. Authors declared a range of funding, grants, fees, and honoraria from the pharmaceutical industry.

Rapid reversal of international normalized ratio, along with systolic blood pressure reduction, in patients with oral anticoagulant–associated intracerebral hemorrhage can significantly reduce the rates of hematoma enlargement and in-hospital mortality, a retrospective cohort study has found.

In the German study of 1,176 patients with oral anticoagulant–associated intracerebral hemorrhage, patients whose INR was reduced below 1.3 with use of vitamin K agonists and whose systolic BP was reduced below 160 mm Hg within 4 hours of admission had a 72% reduction in the rates of hematoma enlargement and 40% reduction in in-hospital mortality, compared with patients who did not achieve those reductions in that time frame.

Researchers also showed that there were no significant increases in hemorrhagic complications, but fewer ischemic complications, among patients who resumed oral anticoagulation, according to the study published online Feb. 24 in JAMA.

“Consensus exists that elevated international normalized ratio (INR) levels should be reversed to minimize hematoma enlargement, yet mode, timing, and extent of INR reversal are unclear [and] valid data on safety and clinical benefit of [oral anticoagulant] resumption are missing and remain to be established,” wrote Dr. Joji B. Kuramatsu of the University of Erlangen-Nuremberg, Germany, and coauthors (JAMA 2015;313:824-836 [doi:10.1001/jama.2015.0846]).

The study was supported by the Johannes and Frieda Marohn Foundation. Authors declared a range of funding, grants, fees, and honoraria from the pharmaceutical industry.