Akademik Veri Yönetim Sistemi
European Society of Emergency Medicine 2022 Congress, Berlin, Almanya, 15 Ekim 2022, ss.495
Introduction: Spontaneous
intracerebral hemorrhages (ICH) are a major risk factor for mortality and
morbidity, especially in the elderly population due to their increased need for
anticoagulation for various diseases. Warfarin was the choice of agent for
patients with atrial fibrillation and/or mechanical valve replacements but
recent introduction of direct oral anticoagulants (DOAC) allowed clinicians to
prescribe those drugs as well. Risk and prognosis of patients who are taking
DOACs are relatively unknown thus far. We compared patients who received
no-anticoagulation, warfarin, or DOAC before admission in terms of the hematoma
volumes, mortalities, and morbidities of the ICH patients that have been
admitted to our Emergency Department (E.D.) in one year.
Patients & Methods: This research is a
single-centered, cross-sectional, retrospective study which is conducted in a
third-level university hospital. Information about patients who were admitted
to the E.D. between 21.04.2021 and 21.04.2022, and got diagnosed with ICH was
collected from the hospital database. Patients who were younger than eighteen
years old and had traumatic bleedings were excluded. Primary outcome was to
determine hematoma volumes of the patients. Secondary outcome was to determine
mortality and morbidity of the patients and factors that affect those rates.
Results: After exclusion 108 patients were
included in the study and 49.1% (n=53) were women. Median age of the patients
was 70.0 [IQR: 60.0-79.0]. Thirty-four patients (31.5%) died during their
hospital stay, 12 patients (11.1%) were discharged without any sequela and rest
had various neurological morbidities on their discharge. Eight patients were
using DOACs (7.4%) and 7 patients were using Warfarin (6.5%) and none were
using unfractionated heparin or low-molecular-weight heparin (Table-1).
Hematoma volumes were higher in patients who died with a median volume of
13.45mL [IQR: 2.87-24.65] (p=0.008). Patients who had ICH which has extended
into the ventricles ((n=19) 55.9%) were at higher risk of mortality
(p<0.001) (Table-2). Comparing DOACs, Warfarin and no-anticoagulation group
we have found that hematoma volumes did not differ significantly with 4.8mL
[IQR: 1.42-16.67], 4.8mL [IQR: 0.4-11.8], 6.2mL [IQR: 2.15-16.5] for groups
respectively (p=0.733). Mortalities of these groups were: n=4 (50%), n=2
(28.6%) and n=28 (30.1%) respectively (p=0.493).
Discussion:
Higher hematoma volumes were found to be related to mortality which is in line
with the current literature. While statistically insignificant, oral
anticoagulation of any kind does not increase the hematoma volumes of ICH
patients on admission. This might be due to the mechanism of the disease as
hypertensive bleeds are the most common etiology. Use of anticoagulation (DOACs
more than Warfarin) was associated with higher mortality in our study. This
finding was not statistically significant but it might have clinical
significance. Another point that should be mentioned was the median age of
patients who were using DOACs were higher which might have contributed to the
mortality rates. ICHs could be fatal with or without anticoagulation. While
more studies are needed to determine the safest agent to use in patients who
need anticoagulation, all patients should be evaluated carefully for their
hematoma volumes as it can determine the prognosis of these patients.