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Verfasst von:Kuramatsu, Joji Benjamin [VerfasserIn]   i
 Köhrmann, Martin [VerfasserIn]   i
Titel:Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage
Verf.angabe:Joji B. Kuramatsu, MD; Stefan T. Gerner, MD; Peter D. Schellinger, MD; Jörg Glahn, MD; Matthias Endres, MD; Jan Sobesky, MD; Julia Flechsenhar, MD; Hermann Neugebauer, MD; Eric Jüttler, MD; Armin Grau, MD; Frederick Palm, MD; Joachim Röther, MD; Peter Michels, MD; Gerhard F. Hamann, MD; Joachim Hüwel, MD; Georg Hagemann, MD; Beatrice Barber, MD; Christoph Terborg, MD; Frank Trostdorf, MD; Hansjörg Bäzner, MD; Aletta Roth, MD; Johannes Wöhrle, MD; Moritz Keller, MD; Michael Schwarz, MD; Gernot Reimann, MD; Jens Volkmann, MD; Wolfgang Müllges, MD; Peter Kraft, MD; Joseph Classen, MD; Carsten Hobohm, MD; Markus Horn, MD; Angelika Milewski, MD; Heinz Reichmann, MD; Hauke Schneider, MD; Eik Schimmel, MD; Gereon R. Fink, MD; Christian Dohmen, MD; Henning Stetefeld, MD; Otto Witte, MD; Albrecht Günther, MD; Tobias Neumann-Haefelin, MD; Andras E. Racs, MD; Martin Nueckel, MD; Frank Erbguth, MD; Stephan P. Kloska, MD; Arnd Dörfler, MD; Martin Köhrmann, MD; Stefan Schwab, MD; Hagen B. Huttner, MD
E-Jahr:2015
Jahr:February 24, 2015
Umfang:13 S.
Fussnoten:Gesehen am 30.11.2018
Titel Quelle:Enthalten in: American Medical AssociationThe journal of the American Medical Association
Ort Quelle:Chicago, Ill. : American Medical Association, 1883
Jahr Quelle:2015
Band/Heft Quelle:313(2015), 8, Seite 824-836
ISSN Quelle:1538-3598
Abstract:Importance: Although use of oral anticoagulants (OACs) is increasing, there is a substantial lack of data on how to treat OAC-associated intracerebral hemorrhage (ICH). Objective: To assess the association of anticoagulation reversal and blood pressure (BP) with hematoma enlargement and the effects of OAC resumption. Design, Setting, and Participants: Retrospective cohort study at 19 German tertiary care centers (2006-2012) including 1176 individuals for analysis of long-term functional outcome, 853 for analysis of hematoma enlargement, and 719 for analysis of OAC resumption. Exposures: Reversal of anticoagulation during acute phase, systolic BP at 4 hours, and reinitiation of OAC for long-term treatment. Main Outcomes and Measures: Frequency of hematoma enlargement in relation to international normalized ratio (INR) and BP. Incidence analysis of ischemic and hemorrhagic events with or without OAC resumption. Factors associated with favorable (modified Rankin Scale score, 0-3) vs unfavorable functional outcome. Results: Hemorrhage enlargement occurred in 307 of 853 patients (36.0%). Reduced rates of hematoma enlargement were associated with reversal of INR levels <1.3 within 4 hours after admission (43/217 [19.8%]) vs INR of ≥1.3 (264/636 [41.5%]; P < .001) and systolic BP <160 mm Hg at 4 hours (167/504 [33.1%]) vs ≥160 mm Hg (98/187 [52.4%]; P < .001). The combination of INR reversal <1.3 within 4 hours and systolic BP of <160 mm Hg at 4 hours was associated with lower rates of hematoma enlargement (35/193 [18.1%] vs 220/498 [44.2%] not achieving these values; OR, 0.28; 95% CI, 0.19-0.42; P < .001) and lower rates of in-hospital mortality (26/193 [13.5%] vs 103/498 [20.7%]; OR, 0.60; 95% CI, 0.37-0.95; P = .03). OAC was resumed in 172 of 719 survivors (23.9%). OAC resumption showed fewer ischemic complications (OAC: 9/172 [5.2%] vs no OAC: 82/547 [15.0%]; P < .001) and not significantly different hemorrhagic complications (OAC: 14/172 [8.1%] vs no OAC: 36/547 [6.6%]; P = .48). Propensity-matched survival analysis in patients with atrial fibrillation who restarted OAC showed a decreased HR of 0.258 (95% CI, 0.125-0.534; P < .001) for long-term mortality. Functional long-term outcome was unfavorable in 786 of 1083 patients (72.6%). Conclusions and Relevance: Among patients with OAC-associated ICH, reversal of INR <1.3 within 4 hours and systolic BP <160 mm Hg at 4 hours were associated with lower rates of hematoma enlargement, and resumption of OAC therapy was associated with lower risk of ischemic events. These findings require replication and assessment in prospective studies.
DOI:doi:10.1001/jama.2015.0846
URL:Bitte beachten Sie: Dies ist ein Bibliographieeintrag. Ein Volltextzugriff für Mitglieder der Universität besteht hier nur, falls für die entsprechende Zeitschrift/den entsprechenden Sammelband ein Abonnement besteht oder es sich um einen OpenAccess-Titel handelt.

Volltext: http://dx.doi.org/10.1001/jama.2015.0846
 Volltext: https://jamanetwork.com/journals/jama/fullarticle/2130317
 DOI: https://doi.org/10.1001/jama.2015.0846
Datenträger:Online-Ressource
Sprache:eng
K10plus-PPN:1584666471
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