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22. European Stroke Conference 594 © 2013 S. Karger AG, Basel Scientific Programme 25 Intracerebral/subarachnoid haemorrhage and venous diseases ICH due to warfarin use is associated with early clinical deterioration, larger hematoma at presentation, and increased mortality S. Curtze1, D. Strbian2, A. Meretoja3, J. Putaala4, H. Eriksson5, E. Haapaniemi6, S. Mustanoja7, T. Sairanen8, J. Satopää9, H. Silvennoinen10, M. Niemelä11, M. Kaste12, T. Tatlisumak13 Department of Neurology, Helsinki University Central Hospital, Helsinki, FINLAND1, De-partment of Neurology, Helsinki University Central Hospital, Helsinki, FINLAND2, Department of Neurology, Helsinki University Central Hospital, Helsinki, FINLAND3, Department of Neurology, Helsinki University Central Hospital, Helsinki, FINLAND4, Department of Neurology, Helsinki University Central Hospital, Helsinki, FINLAND5, Department of Neurology, Helsinki Universi-ty Central Hospital, Helsinki, FINLAND6, Department of Neurology, Helsinki University Central Hospital, Helsinki, FINLAND7, Department of Neurology, Helsinki University Central Hospital, Helsinki, FINLAND8, Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, FINLAND9, Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, FINLAND10, Depart-ment of Neurosurgery, Helsinki University Central Hospital, Helsinki, FINLAND11, Department of Neurology, Helsinki University Central Hospital, Helsinki, FINLAND12, Department of Neurology, Helsinki University Central Hospital, Helsinki, FINLAND13 Background: Oral anticoagulation (OAC) is a cause of intracerebral hemorrhage (ICH). We com-pared characteristics of OAC-associated ICH with non-OAC-associated ICH. Methods: We performed a retrospective chart review of consecutive ICH patients treated at the Hel-sinki University Central Hospital, January 2005 to March 2010 (n=1,013). An ICH was considered to be OAC-associated if the patient was on warfarin at ICH onset. Deterioration was defined as any neurological worsening. Radiological measures including lesion volume, hematoma growth within 7 days (>6 ml or >33%) and intraventricular rupture were analyzed. Results: There were 132 (13%) OAC-associated ICH patients of whom 50% had therapeutic INR (2.0 to 3.0), 7% had INR <2.0, and 43% had high INR (>3.0) on admission. The ICH patients on OAC were older (median 76 vs. 66 years) and had more severe symptoms (median NIHSS 14 vs. 10) on admission than patients with non OAC-associated ICHs. Patients with OAC-associated ICH deteriorated more often (66.7% vs. 45.6%), but did not have more hematoma growth (36% vs. 25%; p=0.09). Deterioration and hematoma growth were associated with increased 3-month mortality, OR 2.38; CI 1.62-3.51 and OR 4.65; CI 2.89-7.48 respectively. After adjustment for confounding factors, 3-month mortality was associated with age, male gender, NIHSS on arrival, ICH volume, intraventricular rupture of hemorrhage, low thrombocytes, and INR at baseline (OR 1.06; CI 1.03-1.09 per 0.1 of INR). Increased 3-month mortality was associated also with therapeutic (OR 3.59; CI 1.50-8.60) and high (OR 5.26; CI 1.94-14.27) INR values, compared to patients not on OAC. Conclusions: Patients with OAC-associated ICH deteriorated more often, showed increased hema-toma volume on admission, and had higher mortality compared to patients with ICH not related to OAC. Higher INR on admission was associated with increased mortality. Treatment of OAC-associ-ated ICH needs urgent improvement. 24 Intracerebral/subarachnoid haemorrhage and venous diseases Cerebral venous thrombosis associated with medications and medical procedures (iatrogenic CVT): ISCVT experience P. Canhão1, J.M. Ferro2, F. Barinagarrementeria3, M-G. Bousser4, J. Stam5 ISCVT Investigators Hospital de Santa Maria, University of Lisbon, Lisbon, PORTUGAL1, Hospital de Santa Ma-ria, University of Lisbon, Lisbon, PORTUGAL2, Instituto Nacional de Neurologia y Neurocirurgia, México City, MEXICO3, Hôpital Lariboisière, Paris, FRANCE4, Academic Medical Centre Amster-dam, Amsterdam, THE NETHERLANDS5 The risk of cerebral venous thrombosis (CVT) is increased if drugs with a prothrombotic effect are prescribed or if a diagnostic or therapeutic procedure which interferes with cerebral venous integ-rity and drainage is performed. Method. We searched the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) databases for cases of CVT whose cause was attributed (alone or in combination with other risk factors) to medications (except OC) or to diagnostic or therapeu-tic procedures (“iatrogenic” CVT). Results. We identified 71 “iatrogenic” CVT out of 624 patients (11.4%). Most frequent factors were medications (47:HRT,27; steroids, 11; chemotherapy, 7), recent surgery (17); LP (12); venous catheter (7). Iatrogenic CVT patients were older than the remaining CVT patients (44.2 vs. 38.5 years, P=003). Presentation with isolated intracranial hypertension (12.7 vs. 24.2%, p=0.29), papilledema (14.3 vs. 30.1%, p=0.006), headache (81.7 vs. 89.7%, p=0.045), diplopia/oculomotor palsies (5.6 vs. 14.5%, p=0.40) was less frequent in the iatrogenic group. There were no other clinical differences between the two groups. Delays in admission and diagnosis were similar. Additional risk factors were present in 54 (76.1%) “iatrogenic” cases. Malignancies were more frequent among “iatrogenic” CVT patients (P <0.001). The outcome of “iatrogenic” CVT was similar as in the remaining ISCVT cohort, except for a trend to increased mortality among the “iat-rogenic” group: 10/71 (14.4%) vs. 42/553 (7.6%; P=0.06). Conclusion. We identified iatrogenic risk factors for cerebral sinus thrombosis in 11.4 % of the ISCVT cohort, often in the presence of other risk factors. In patients with medical situations associated with a protrombotic state and an interven-tion or a medication which could cause venous thrombosis, CVT should be considered in the differ-ential diagnosis of new neurological symptoms or clinical deterioration.


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