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- W2191110229 abstract "OBJECTIVE: Evaluate the predictors of hematoma expansion(HE) and in-hospital mortality in warfarin-related intracerebral hemorrhage(wr-ICH), and their relationship to INR reversal. BACKGROUND: Wr-ICH is a devastating disease with case-fatality of 55[percnt]. Therapy entails INR reversal, however whether this improves outcomes is not well established. DESIGN/METHODS: Consecutive cases of ICH admitted between 11/2008-04/2014,(n=287) were reviewed for patients with wr-ICH and INR values >1.4. HE was defined as more than 6ml or 33[percnt] growth between baseline and follow-up CT scans. We compared baseline characteristics and time-to-INR reversal between patients with HE, as well as in-hospital mortality, and those without. RESULTS: In 37 patients with wr-ICH, median baseline ICH volume was 21ml and median time from CT to INR reversal was 471 minutes. Patients with larger ICH volumes had shorter time-to-INR reversal (Spearman’s correlation coefficient: -0.46,p<0.01), higher NIHSS (0.56,p=0.001) and lower Glasgow coma scale(GCS, -0.42,p=0.02). HE and in-hospital mortality occurred in 65[percnt] and 30[percnt] of cases. In comparison to patients without HE, those with HE had overrepresentation of lobar ICH (59[percnt] vs. 11[percnt],p=0.04) and in-hospital mortality (41[percnt] vs. 0[percnt],p=0.06), and underrepresentation of left ventricular hypertrophy (LVH, 30[percnt] vs. 86[percnt],p=0.05). Patients with in-hospital mortality had higher baseline ICH volumes (median: 61 ml vs. 19 ml,p=0.10), lower GCS (median: 11 vs. 14,p=0.08), and less LVH (0[percnt] vs. 62[percnt],p=0.06). The improved outcomes observed with LVH were not explained by medication use, hematoma volume or ICH topography. When analyzing patients with baseline volumes <30ml, in-hospital mortality was associated with higher time-to-INR reversal (median: 826 vs. 535 minutes,p=0.07). CONCLUSIONS: Our results suggest that patients with larger wr-ICH volumes receive more urgent INR reversal, whereas it is those with smaller volumes that are most likely to benefit. LVH may be protective against HE possibly via accompanying cerebral vascular changes that are resistant to hematoma expansive forces. Study Supported by: None Disclosure: Dr. Patel has nothing to disclose. Dr. Masoud has nothing to disclose. Dr. Lau has nothing to disclose. Dr. Romero has nothing to disclose. Dr. Babikian has nothing to disclose. Dr. Burns has nothing to disclose. Dr. Kase has nothing to disclose. Dr. Shoamanesh has nothing to disclose." @default.
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- W2191110229 date "2015-04-06" @default.
- W2191110229 modified "2023-09-30" @default.
- W2191110229 title "Time-to-INR reversal, Predictors of Hematoma Expansion and In-hospital Mortality in Warfarin-related Intracerebral Hemorrhage. (P3.092)" @default.
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