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The Prognostic Impact of Oral Anticoagulant Treatment in Patients With Intracerebral Hemorrhage—Reply
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In reply
We agree that hematoma volume and level of consciousness on admission are important predictors of in-hospital mortality from ICH. Indeed, as we discussed, a plausible mechanism for the effect of warfarin sodium on ICH mortality is through the generation of larger hematoma volumes.1 We have investigated this question in a follow-up study and found that while patients receiving warfarin do not have larger hemorrhage volumes on presentation, they do have an increased risk of in-hospital expansion of these volumes.2 Notably, the effect of warfarin on mortality was independent of level of consciousness on admission.
Neurosurgical intervention occurred in fewer than 10% of patients in our cohort and did not affect the relationship between warfarin and mortality. It is in fact far from clear that neurosurgical intervention has any effect on outcome in supratentorial ICH.3-4 This contrasts with cerebellar ICH, a disease not included in our study, for which . . . [Full Text of this Article]
AUTHOR INFORMATION
Jonathan Rosand, MD;
Steven M. Greenberg, MD, PhD
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