gms | German Medical Science

Objective: Spontaneous intracerebral hemorrhage (ICH) is increasingly often related to anticoagulation therapy. Experimental studies suggest a better endogenous ICH clearance via the Virchow Robin spaces because anticoagulation prevented clotting, thereby possibly leading to less perihemorrhagic edema. It has been shown likewise in experimental studies that the fibrinolytic therapy with recombinant tissue Plasminogen Activator (rtPA) can increase the volume of the delayed perihemorrhagic edema. Putting the findings together, one might assume that patients with anticoagulation have a smaller edema than patients without anticoagulation. Thus, it was the aim of the study to evaluate the impact of running anticoagulation therapy on the initial and delayed perihemorrhagic edema in patients with supratentorial ICH managed by administration of rtPA and subsequent clot lysis.

Methods: A retrospective analysis concerning the presence of anticoagulation therapy at the moment of ICH diagnosis was performed in patients with supratentorial ICH treated by fibrinolytic therapy. Volumentric measurements of the perihemorrhagic edema were performed on the initial CT scan and on day 5 after ICH-onset. The correlation of anticoagulation with the perihemorrhagic edema initially and on day 5 was evaluated..

Results: A total of 114 patients were included in the study. The mean initial hematoma volume was 55ml. Anticoagulation therapy at bleeding was present in 36% (41/114) of all patients. An anticoagulation therapy showed a significant correlation with larger initial hematoma volume (linear regression p=0.02). There was no significant difference in the volume of the initial perihemorrhagic edema between the patients with and without anticoagulation. A significantly higher volume of the delayed edema was seen in the patients with anticoagulation compared to those without anticoagulation (Fisher’s Exact test OR=5.65, 95%CI 1.54-20.4, p=0.01).

Conclusion: Patients with anticoagulation therapy at the moment of the spontaneous intracerebral hemorrhage have a significantly higher risk for a more extensive volume of the delayed perihemorrhagic edema, possibly counteracting the positive effect of hematoma volume reduction by the fibrinolytic therapy. Anticoagulation has no positive influence on the initial perihemorrhagic edema.