Abstract Details

Title Warfarin use, intensity of anticoagulation, and occurrence of intracerebral hemorrhage in stroke patients: An analysis of Taiwan Stroke Registry data

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S15 - Intracerebral Hemorrhage and SAH (1:00 PM-1:11 PM)

Poster/Presentation
Number 001

Background Warfarin use is increasingly seen in patients admitted with stroke. We performed this study to identify the intensity of anticoagulation, and patterns of stroke occurrence.

Objective In Ischemic stroke patients, rigorous monitoring of INR to prevent intracerebral hemorrhage is essential.

Design/Methods Patients with diagnosis of ischemic stroke, transient ischemic attack, and intracerebral hemorrhage who were using warfarin were selected from Taiwan Stroke Registry which has had a collection of more than 130,000 registries since 2010. We determined the proportion (with 95% confidence intervals [CI]) of developing intracerebral hemorrhage (ICH) among patients who were on warfarin with or without concurrent aspirin based on international normalized ratio [INR].

Results Among the 1968 patients who were using warfarin alone and admitted with stroke, the INR was <2.0, 2.0-2.0, and >3.0 in 1591, 92, and 62 patients, respectively. For patients with INR < 2.0, the risk of developing ICH was 5.8% compared to those with INR between 2,0 and 3,0 whose risk of developing ICH increased to 27.7% (95% CI 22.2-33.9%). Among those with INR greater than 3.0, the risk of developing ICH was further elevated to 53.8 % (95% CI 46.0-61.3) (see Table). A total of 300 patients were using warfarin and aspirin concurrently. Among those patients who took aspirin together with warfarin, the risk of developing ICH was two folds higher (9.2% versus 5.4%) with INR < 2.0. Aspirin effect in increasing warfarin-related ICH risk was less pronounced among those patients with INR> 2.0.

Conclusions These findings, reflecting real world practice outcomes, suggest that in the prevention of thromboembolic event with warfarin the need for rigorous monitoring of INR levels to lower the risk of developing ICH cannot be over emphasized.

Authors/Disclosures
Hamza I. Maqsood, MD (Dept of Neurology) PRESENTER	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.
Mushtaq H. Qureshi, MD	No disclosure on file
	No disclosure on file
	No disclosure on file

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