Zubkov Alexander Y, Mandrekar Jayawant N, Claassen Daniel O, Manno Edward M, Wijdicks Eelco F M, Rabinstein Alejandro A
Department of Neurology, Mayo Clinic, 200 First St NW, Rochester, MN 55901, USA.
Arch Neurol. 2008 Oct;65(10):1320-5. doi: 10.1001/archneur.65.10.1320.
Intracerebral hemorrhage (ICH) associated with warfarin sodium therapy is becoming more common as the use of this medication increases in the aging population.
To delineate factors associated with early mortality, determine variables responsible for poor functional outcome, and evaluate possible reasons for expansion of hemorrhage and associated parenchymal edema.
Retrospective study of clinical and radiologic information for 88 patients with warfarin-associated ICH.
A single hospital. Patients Eighty-eight consecutive patients with warfarin-associated ICH.
Patients were included if the international normalized ratio (INR) at presentation with ICH was 1.5 or greater. Computed tomographic scans were reviewed for volumetric analysis of hematoma and perihematomal edema volume. Outcome variables included 7-day mortality, hematoma enlargement, and functional outcome based on the modified Rankin Scale score.
Seven-day mortality (39.8%) was associated with a lower Glasgow Coma Scale sum score and larger ICH volume at presentation. Univariate analysis revealed that a lower Glasgow Coma Score sum score, larger initial ICH volume, higher initial and 48-hour maximum glucose concentrations, and higher percentage of ICH expansion were significantly associated with poor functional outcome at hospital discharge. At multivariate analysis, only Glasgow Coma Score and ICH volume remained significantly associated with functional outcome measured at hospital discharge and at the last follow-up visit. Conversely, INR at presentation, time to INR correction, initial blood pressure, and enlargement of edema were not associated with functional outcome either at hospital discharge or at the last follow-up. Neither serum glucose concentration at admission nor highest level during the first 48 hours had any correlation with ICH or parenchymal edema enlargement. In addition, neither initial INR nor time to INR correction correlated with expansion of ICH or parenchymal edema.
Lower level of consciousness at presentation and larger initial ICH volume predict poor prognosis in patients with warfarin-associated ICH. In our study population, INR at presentation was not associated with functional outcome.
随着华法林钠在老年人群中的使用增加，与华法林钠治疗相关的脑出血（ICH）越来越常见。
确定与早期死亡率相关的因素，确定导致功能预后不良的变量，并评估出血扩大及相关实质水肿的可能原因。
对88例与华法林相关的ICH患者的临床和放射学信息进行回顾性研究。
一家医院。患者88例连续的与华法林相关的ICH患者。
如果患者脑出血发作时国际标准化比值（INR）为1.5或更高，则纳入研究。对计算机断层扫描进行回顾，以对血肿和血肿周围水肿体积进行容积分析。结局变量包括7天死亡率、血肿扩大以及基于改良Rankin量表评分的功能结局。
7天死亡率（39.8%）与较低的格拉斯哥昏迷量表总分以及脑出血发作时较大的ICH体积相关。单因素分析显示，较低的格拉斯哥昏迷量表总分、较大的初始ICH体积、较高的初始和48小时最高血糖浓度以及较高的ICH扩大百分比与出院时功能预后不良显著相关。多因素分析显示，只有格拉斯哥昏迷量表评分和ICH体积在出院时和最后一次随访时仍与功能结局显著相关。相反，脑出血发作时的INR、INR纠正时间、初始血压和水肿扩大在出院时或最后一次随访时均与功能结局无关。入院时血清葡萄糖浓度和最初48小时内的最高水平与ICH或实质水肿扩大均无相关性。此外，初始INR和INR纠正时间均与ICH或实质水肿扩大无关。
脑出血发作时意识水平较低和初始ICH体积较大预示着与华法林相关的ICH患者预后不良。在我们的研究人群中，脑出血发作时的INR与功能结局无关。
