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

ABSTRACT

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.

Download full-text

Full-text

Available from: Javier Romero
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Apr 2013 · PLoS ONE
  • Source
    • "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) "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Jun 2012
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Spontaneous intracerebral hemorrhage (sICH) represents the most feared subtype of stroke. Despite the intracranial bleeding risk associated to oral anticoagulant (OAT) with vitamin K antagonists (VKA) has remained constant, the wider use of VKA over the last 20 years has proven the increasing of OAT related ICH (OAT-sICH). Aim of the study To evaluate whether the percentage of OAT-sICH is increased in our hospital and which has been the practical management of OAT urgent reverse and whether this management has changed over the years. Methods We retrospectively analyzed data records of patients consecutively admitted in the Internal Medicine ward of our hospital for ICH since 2006. Of these patients we retrieved clinical, radiological and laboratory findings aimed to investigate the severity of sICH, the antithrombotic drugs used before admission, the INR values in OAT-sICH patients at hospital arrival and after OAT reverse and the mortality burden. Results In the analyzed period 122 patients, 56 males, with mean age 79.8±9.6 years, were admitted. 25 patients (20.4%) were on OAT, whereas 44 (36%) were treated by antiplatelets agents. The percentage of OATsICH increased from 9% in 2006 to 31.5% in the first ten months of 2011. 39 patients (31.96%) died. Mortality was 56% in OAT-sICH patients, 40.9% in antiplatelets related sICH, while mortality was 12.8% in patients not treated with antithrombotic drugs. Mean values of INR at hospital arrival were 3.55±2.39. One patient (4%) presented INR value <2.0, 48% of patients was in therapeutic range (2.0–3.0), 28% had INR values between 3.0 and 4.0, 8% 4.0–5.0, 12% INR values >5.0 (8%–9.0). OAT reverse was performed by using prothrombin complex concentrate (CCP) in 80% of patients, whereas 12% was treated with fresh frozen plasm. 96% of patients received intravenous vitamin K1. At the end of first dose of CCP mean values of INR were 1.61±0.76. Median number of INR assays until demonstration of OAT reversal was 3. Conclusion OAT-sICH is an increasing emergency due to wider use of VKA. Laboratory physicians are called to give quick results of INR as the urgent OAT reverse is imperative. Therefore close collaboration between emergency and laboratory physicians is fundamental.
    Full-text · Article · Jun 2012 · Rivista Italiana della Medicina di Laboratorio
Show more