Restarting Anticoagulation after Warfarin Associated Intracerebral Haemorrhage

Abstract

Warfarin is approved for long-term anticoagulation management for treatment and prevention of thrombo-embolic events as venous thromboembolism, antiphospholipid syndrome, atrial fibrillation, valvular heart disease, prosthetic valves and other medical conditions. Dose of warfarin can be tested and modified according to the international normalized ratio (INR) (Kearon et al., 2012). Warfarin-associated intracerebral haemorrhage (WAICH) is a high mortality disease of increasing prevalence (Liotta et al., 2012). Non-traumatic intracerebral haemorrhage most commonly results from hypertensive damage to blood vessel walls (e.g.; hypertension, eclampsia), but it also may be due to autoregulatory dysfunction with excessive cerebral blood flow, rupture of an aneurysm or arteriovenous malformation (AVM), arteriopathy, haemorrhagic necrosis (e.g.; tumor, infection),or other several causes (Cervera et al., 2012). Nonpenetrating and penetrating cranial trauma are also common causes of intracerebral haemorrhage. Patients who experience blunt head trauma and subsequently receive Summary warfarin or clopidogrel are considered at increased risk for traumatic intracranial haemorrhage (Nishijima et al., 2012). The acute management of hypertension and surgical interventions, mostly relevant to intra-parenchymal bleed haemorrhages. Anti-hypertensive therapy in the acute phase of ICH, elevated blood pressure is commonly encountered, with evidence linking acute hypertension to increased mortality, disability, and possibly risk of hematoma growth (Tawil and Duprey, 2012). The risk of recurrent ICH is high in ICH patients, and was equally high among non-OAC-treated or OAC treated patients, whereas the risk of recurrent ICH slightly lower in patients who received antiplatelet therapy. Factors contributing to recurrent ICH have been reported in different studies and include increasing age, concomitant use of aspirin or non-steroidal anti-inflammatory drugs, uncontrolled hypertension, etc. As previously shown in clinical trials and nation-wide registries, the HAS-BLED score is the only bleeding risk score that is predictive of major bleeding risk and reflects the risk factors commonly associated with this complication (Poli et al., 2014).