Comparison of Hematoma Shape and Volume Estimates in Warfarin Versus Non-Warfarin-Related Intracerebral Hemorrhage

Division of Neurology, University of Maryland Medical Center, Baltimore, MD, USA.
Neurocritical Care (Impact Factor: 2.44). 10/2009; 12(1):30-4. DOI: 10.1007/s12028-009-9296-7
Source: PubMed


Hematoma volume is a major determinant of outcome in patients with intracerebral hemorrhage (ICH). Accurate volume measurements are critical for predicting outcome and are thought to be more difficult in patients with oral anticoagulation-related ICH (OAT-ICH) due to a higher frequency of irregular shape. We examined hematoma shape and methods of volume assessment in patients with OAT-ICH.
We performed a case-control analysis of a prospectively identified cohort of consecutive patients with ICH. We retrospectively reviewed 50 consecutive patients with OAT-ICH and 50 location-matched non-OAT-ICH controls. Two independent readers analyzed CT scans for hematoma shape and volume using both ABC/2 and ABC/3 methods. Readers were blinded to all clinical variables including warfarin status. Gold-standard ICH volumes were determined using validated computer-assisted planimetry.
Within this cohort, median INR in patients with OAT-ICH was 3.2. Initial ICH volume was not significantly different between non-OAT-ICH and OAT-ICH (35 +/- 38 cc vs. 53 +/- 56 cc, P = 0.4). ICH shape did not differ by anticoagulation status (round shape in 10% of OAT-ICH vs. 16% of non-OAT-ICH, P = 0.5). The ABC/3 calculation underestimated median volume by 9 (3-28) cc, while the ABC/2 calculation did so by 4 (0.8-12) cc.
Hematoma shape was not statistically significantly different in patients with OAT-ICH. Among bedside approaches, the standard ABC/2 method offers reasonable approximation of hematoma volume in OAT-ICH and non-OAT-ICH.

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    • "It has been widely applied in clinical analysis and treatments internationally due to its simplicity, practicability and accuracy [14], [20], [22]. However, as it often overestimated or underestimated the volume of irregular shaped hemorrhage, researchers began to question its accuracy [20], [23], [24], [25], [26]. Therefore, Zhao et al introduced an updated formula 2/3SH which evolved from the bulk formula of ellipsoid, and proved that it was simpler and more accurate than formula 1/2ABC, 1/3ABC and Tada [27], [28]. "
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    ABSTRACT: To compare the accuracy of formula 1/2ABC with 2/3SH on volume estimation for hypertensive infratentorial hematoma. One hundred and forty-seven CT scans diagnosed as hypertensive infratentorial hemorrhage were reviewed. Based on the shape, hematomas were categorized as regular or irregular. Multilobular was defined as a special shape of irregular. Hematoma volume was calculated employing computer-assisted volumetric analysis (CAVA), 1/2ABC and 2/3SH, respectively. The correlation coefficients between 1/2ABC (or 2/3SH) and CAVA were greater than 0.900 in all subgroups. There were neither significant differences in absolute values of volume deviation nor percentage deviation between 1/2ABC and 2/3SH for regular hemorrhage (P>0.05). While for cerebellar, brainstem and irregular hemorrhages, the absolute values of volume deviation and percentage deviation by formula 1/2ABC were greater than 2/3SH (P<0.05). 1/2ABC and 2/3SH underestimated hematoma volume each by 10% and 5% for cerebellar hemorrhage, 14% and 9% for brainstem hemorrhage, 19% and 16% for regular hemorrhage, 9% and 3% for irregular hemorrhage, respectively. In addition, for the multilobular hemorrhage, 1/2ABC underestimated the volume by 9% while 2/3SH overestimated it by 2%. For regular hemorrhage volume calculation, the accuracy of 2/3SH is similar to 1/2ABC. While for cerebellar, brainstem or irregular hemorrhages (including multilobular), 2/3SH is more accurate than 1/2ABC.
    PLoS ONE 04/2013; 8(4):e62286. DOI:10.1371/journal.pone.0062286 · 3.23 Impact Factor
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    • "The classic presentation of sICH includes the sudden onset of a focal neurological deficit that progresses over minutes to hours with accompanying headache, nausea, vomiting, decreased consciousness, and elevated blood pressure.5) The hematoma volume is the most potent predictor of mortality and poor functional outcome in patients with sICH.17) Furthermore, acute expansion of the hematoma within an hour to a day, has been reported as a cause of severe neurologic deterioration and death.14) "
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    ABSTRACT: Rapid reduction of a large acute subdural hematoma has been frequently reported. In my knowledge, however, it was rarely reported that rapid spontaneous reduction occurred in large volume of spontaneous intracerebral hematoma (sICH). We describe a patient with a rapid spontaneous decrease in the volume of a large hematoma. A 73-year-old man presented semi-comatose mentality. Initial brain computed tomography (CT) revealed the huge sICH. An emergency operation was planned, but was not performed due to the refusal of patient's family. Therefore, we decided to treat with conservative therapy. However, follow-up brain CT 16 hours after initial scan showed a remarkable reduction of previous sICH. The mechanism involving the spontaneous rapid decrease of the hematoma is presumed to occur through redistribution in brain atrophy, compression effect from the increased intracranial pressure and dilution through a wash out by the cerebrospinal fluid.
    06/2012; 14(2):104-7. DOI:10.7461/jcen.2012.14.2.104
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    ABSTRACT: Premesse L’emorragia cerebrale intraparenchimale spontanea (sICH) rappresenta la forma più temuta di ictus cerebrale. Nonostante il rischio di sanguinamento intracerebrale associato alla terapia anticoagulante orale (TAO) con farmaci vitamina K antagonisti (VKA) sia rimasto costante, il più ampio uso dei VKA negli ultimi 20 anni ha comportato un incremento delle sICH TAO associate (sICH-TAO). Scopo dello studio Valutare se la percentuale di sICHTAO è aumentata nel nostro ospedale nel corso degli anni e quale è stato e se è cambiato il management pratico del reverse urgente della TAO nel corso degli anni. Metodi Abbiamo analizzato retrospettivamente i dati clinici, strumentali e di laboratorio dei pazienti consecutivamente ricoverati nel reparto di Medicina Interna del nostro Ospedale dal 2006 con lo scopo di valutare la severità clinica della sICH, la terapia antitrombotica assunta prima dell’arrivo in Ospedale, i valori di INR all’arrivo in Ospedale nei pazienti con sICH-TAO e dopo il trattamento di reverse urgente e l’impatto sulla mortalità totale delle sICH-TAO. Risultati Nel periodo analizzato 122 pazienti, 56 maschi, di età media±DS 79,8±9,6 anni, sono stati ricoverati per sICH. 25 pazienti (20,4%) assumevano TAO e 44 (36%) antiaggreganti piastrinici prima dell’evento. La percentuale di sICH-TAO è aumentata dal 9% del 2006 al 31,5% dei primi 10 mesi del 2011. 39 pazienti (31,96%) sono deceduti. La mortalità è risultata del 56% nei pazienti con sICH-TAO, del 40,9% nei pazienti in terapia antiaggregante e del 12,8% nei pazienti che non assumevano terapia antitrombotica. I valori medi di INR all’arrivo in Ospedale sono risultati 3,55±2,39. Un paziente (4%) è risultato avere valori di INR <2,0, il 48% dei pazienti erano in range terapeutico (2,0–3,0), il 28% aveva valori di INR compresi tra 3,0 e 4,0, il 8% 4,0–5,0, il 12% valori di INR >5,0 (8% ≥9,0). Il reverse urgente della TAO è stato effettuato nel 80% dei casi con concentrato di complesso protrombinico (CCP), nel 12% dei casi è stato somministrato plasma fresco congelato e nel 16% dei casi fattore VII ricombinante attivato. Il 96% dei pazienti ha ricevuto l’infusione di vitamina K1. Alla fine della prima infusione di CCP i valori medi di INR sono risultati 1,61±0,76. La mediana di dosaggi dell’INR fino alla dimostrazione della neutralizzazione della TAO è stata 3. Conclusioni Le sICH-TAO sono un’emergenza medica in incremento e ciò è dovuto alla più ampia diffusione dei farmaci VKA. I Medici di Laboratorio sono chiamati a dare risposte rapide dei valori di INR dal momento che il reverse urgente della TAO è imperativa in questo contesto. La stretta collaborazione tra Medici dell’emergenza e di Laboratorio è fondamentale.
    Rivista Italiana della Medicina di Laboratorio 06/2012; 8(2). DOI:10.1007/s13631-012-0046-z
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