Clinical features and microsurgical treatment of warfarin-associated intracerebral hemorrhage (a report of 65 cases)

Abstract

Objective To discuss the clinical features and surgical outcome of warfarin-associated intracerebral hemorrhage (WICH). Methods Sixty-five consecutive patients with WICH were admitted to Department of Neurosurgery, Beijing Anzhen Hospital, Capital Medical University, from January 2005 to May 2016. Their clinical presentation, therapies and outcomes were retrospectively analyzed and discussed with reference to the relevant literatures. Among these patients, 7 cases underwent drilling and drainage, intracranial hematomas were removed by small craniotomy in 50 cases, and both hematoma and bone were removed in the remaining 8 cases. Results The average volume of hematomas in 65 patients was (46.8±13.7) ml.The mean dose of warfarin was 1.5-6.0 mg/d and the average dose was(3.5±1.5) mg/d. The medication time was 3-72 with a mean of 27.8±3.4 months. When the intracerebral hemorrhage occurred, the international normalized ratio (INR) was 1.2-5.6 (mean, 2.7±1.2). WICH occurred in 48 (73.8%) patients within the recommended range of anticoagulation (INR: 2.0-3.0). There were no operative complications in the 65 patients. Based on the Glasgow coma scale (GOS), 28 cases (43.1%) were in grade Ⅴ, 15 cases (23.1%) in grade Ⅳ, 8 cases (12.3%) in grade Ⅲ, 5 cases (7.7%) in grade Ⅱ, and 9 cases (13.8%) in grade Ⅰ (13.8%). Nine cases (13.8%) died, among which 4 cases died due to rebleeding and multiple systemic organ failure occurred in the remaining 5 cases. Conclusion Appropriate surgical timing and surgical treatment of WICH could help prevent the enlargement of hemotomas, improve the prognosis and reduce its mortality. Key words: Intracerebral hemorrhage; Warfarin; Neurosurgical procedures; Anticoagulants