Timing for the Resumption of Anticoagulants after Intracranial Hemorrhage.

IF 1.7 4区 医学 Q4 CLINICAL NEUROLOGY
Sejin Choi, Myoung-Jin Jang, Kangmin Kim, Won-Sang Cho, Hyun-Seung Kang, Jeong Eun Kim, Sung Ho Lee
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Abstract

Objective: To identify the ideal timing for resuming oral or injectable anticoagulants therapy after spontaneous intracranial hemorrhage (sICH).

Methods: We conducted a retrospective cohort study involving 90 patients from a tertiary hospital in Korea, between June 2000 and May 2022, who had experienced sICH while receiving anticoagulant therapy and who resumed treatment within six months. Exclusions were made for trauma-induced hemorrhages and early post-ictus fatalities. The interval between sICH occurrence and anticoagulant resumption was the main exposure variable. We evaluated hemorrhagic and thromboembolic events as outcomes. Multivariate analysis was used to determine the risk factors for post-resumption complications. Receiver operating characteristic (ROC) and locally estimated scatterplot smoothing (LOESS) were used to identify optimal timing.

Results: The median patient age was 71 years, with 56.7% male. Warfarin was the most commonly used anticoagulant prior to sICH (63.3%), and non-vitamin K antagonist oral anticoagulants (NOACs) were used in 22.2%. Within six months of resuming anticoagulants, 9 patients experienced hemorrhagic and 13 experienced ischemic complications. Age ≥80 years was significantly associated with ischemic events (OR 4.29, p=0.048), while NOAC use was strongly associated with hemorrhagic complications (OR 16.59, p=0.003). ROC analyses suggested possible cut-off points for anticoagulants resumption at day 30 for ischemic risk and day 7.5 for hemorrhagic risk, though AUC values were not statistically significant. Risk modeling using LOESS curves indicated that the combined complication risk was lowest when anticoagulants were resumed between days 20 and 22 after ictus.

Conclusion: The findings suggest that approximately 3 weeks after sICH is the optimal time to resume anticoagulants, minimizing the risk of rebleeding or thromboembolic events. These findings may inform clinical decision-making in a broad patient population, though individualized assessment remains essential.

颅内出血后抗凝药物恢复的时机。
目的:探讨自发性颅内出血(siich)后恢复口服或注射抗凝治疗的理想时机。方法:我们在2000年6月至2022年5月期间对韩国一家三级医院的90例患者进行了回顾性队列研究,这些患者在接受抗凝治疗期间经历了siich,并在6个月内恢复了治疗。排除外伤性出血和早期突发性死亡。sICH发生和抗凝恢复之间的时间间隔是主要的暴露变量。我们评估了出血和血栓栓塞事件作为结局。采用多因素分析确定复诊后并发症的危险因素。利用接收者工作特征(ROC)和局部估计散点图平滑(黄土)来确定最佳时序。结果:患者中位年龄71岁,男性56.7%。华法林是sICH前最常用的抗凝剂(63.3%),非维生素K拮抗剂口服抗凝剂(NOACs)占22.2%。在恢复抗凝治疗的6个月内,9例出现出血,13例出现缺血性并发症。年龄≥80岁与缺血性事件显著相关(OR 4.29, p=0.048),而使用NOAC与出血并发症密切相关(OR 16.59, p=0.003)。ROC分析建议在30天恢复抗凝治疗有缺血性风险,7.5天恢复抗凝治疗有出血风险,但AUC值没有统计学意义。利用黄土曲线进行风险建模,结果表明,在致痫后第20 ~ 22天恢复抗凝治疗,合并并发症的风险最低。结论:研究结果表明,siich后约3周是恢复抗凝治疗的最佳时间,可将再出血或血栓栓塞事件的风险降至最低。这些发现可以为广大患者群体的临床决策提供信息,尽管个性化评估仍然是必要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.90
自引率
6.20%
发文量
109
审稿时长
3-8 weeks
期刊介绍: The Journal of Korean Neurosurgical Society (J Korean Neurosurg Soc) is the official journal of the Korean Neurosurgical Society, and published bimonthly (1st day of January, March, May, July, September, and November). It launched in October 31, 1972 with Volume 1 and Number 1. J Korean Neurosurg Soc aims to allow neurosurgeons from around the world to enrich their knowledge of patient management, education, and clinical or experimental research, and hence their professionalism. This journal publishes Laboratory Investigations, Clinical Articles, Review Articles, Case Reports, Technical Notes, and Letters to the Editor. Our field of interest involves clinical neurosurgery (cerebrovascular disease, neuro-oncology, skull base neurosurgery, spine, pediatric neurosurgery, functional neurosurgery, epilepsy, neuro-trauma, and peripheral nerve disease) and laboratory work in neuroscience.
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