Course, management and outcome of oral-anticoagulant-related intracranial haemorrhages

The aim of this study was to compare the clinical course and radiological features of oral anticoagulant (OAC)-related intercranial haemorrhages with those of haemorrhages unrelated to OAC use admitted over the last six years to a tertiary care centre in the North of Scotland. We furthermore wished to determine the measures taken for reversal of OAC therapy and the resulting short-term outcome. Sixty-eight patients had been treated with OACs at the time of intracranial haemorrhage (32% subdural, 62% intracerebral). Patients admitted with OAC-related and unrelated haemorrhages did not differ significantly in any of the clinical features considered. On CT sscan, there was no significant difference according to OAC use in the mean size of subdural (depth 15 +/- 5 vs. 18 +/- 8mm, p=0.36), or intracerebral haematomas (max. diameter 40 +/- 21 vs. 41 +/- 20mm, p=0.73). No reversal measures were taken in 38% of OAC-treated patients. In-hospital mortality was significantly higher for OAC related haemorrhages compared to unrelated haemorrhages (38% vs. 18%, p=0.001). To further elucidate the effects of anticoagulant reversal on the outcome of OAC-related intracranial haemorrhages, a large-scale prospective study is warranted.