Rodríguez-Campello A, Roquer-González J, Gomis-Cortina M, Munteis-Olivas E, Ois-Santiago A, Herraiz-Rocamora J
Unidad de Ictus, Hospital Universitario del Mar, Barcelona, España.
Rev Neurol. 2005;40(1):19-22.
Intracranial haemorrhage (ICH) during dicumarinic treatment is a complication related to anticoagulation intensity with a high level of mortality. The aim of our study is to analize etiology, location and outcome of intracerebral haemorrhages related with anticoagulant therapy.
Over 401 spontaneous intracranial haemorrhages consecutively admitted in the neurological ward, we analyzed the acenocumarol ICH by location, anticoagulation range and factors that conditioned the outcome.
We identified 26 patients, 6.5% of total ICH. Mean age was 75.2 +/- 7.9 years-old, over the rest of ICH. International Normalized Ratio (INR) was less than 2 in 10 patients, between 2 and 3 in six and greater than 3 in ten patients. 8 patients (31%) died, three of them had multiple ICH, but none of them had a INR greater than 2. Dicumarinic haemorrhages were of lobar location in 14 cases (three of them multiples) and deep in 12 cases.
In our study, dicumarinic ICH are responsible of 6.5% total intracranial haemorrhages and they are not in clear relation with excessive anticoagulation. Mortality is slightly greater than the other ICH. Relatively benignity of these patients, the age and lobar location suggest that the etiology of these haemorrhages can be related to a subjacent amyloid angiopathy.
双香豆素治疗期间的颅内出血(ICH)是一种与抗凝强度相关的并发症,死亡率很高。我们研究的目的是分析与抗凝治疗相关的脑出血的病因、部位及预后。
在神经科病房连续收治的401例自发性颅内出血患者中,我们按部位、抗凝范围及影响预后的因素分析了醋硝香豆素所致的颅内出血。
我们确定了26例患者,占颅内出血总数的6.5%。平均年龄为75.2±7.9岁,高于其他颅内出血患者。10例患者的国际标准化比值(INR)小于2,6例在2至3之间,10例大于3。8例患者(31%)死亡,其中3例有多处颅内出血,但均无INR大于2的情况。双香豆素所致出血14例位于脑叶(其中3例为多处出血),12例位于深部。
在我们的研究中,双香豆素所致颅内出血占颅内出血总数的6.5%,且与抗凝过度无明显关系。死亡率略高于其他颅内出血。这些患者相对良好的状态、年龄及脑叶部位提示这些出血的病因可能与潜在的淀粉样血管病有关。