AHA: Clot-Busting Drug OK for Stroke Patients on Warfarin

No increased intracranial hemorrhage risk for acute ischemic stroke patients using warfarin

MONDAY, May 14 (HealthDay News) -- Treating acute ischemic stroke patients who are warfarin users with tissue plasminogen activator (tPA) does not increase the risk of intracranial hemorrhage (ICH), according to a study presented at the American Heart Association's Quality of Care & Outcomes Research 2012 Scientific Sessions, held from May 9 to 11 in Atlanta.

To investigate the association of preadmission warfarin use on the risk of ICH, Ying Xian, M.D., Ph.D., from Duke University in Durham, N.C., and colleagues analyzed data from 23,437 patients with ischemic stroke treated with tPA and having an international normalized ratio (INR) of ≤1.7.

Prior to admission, the researchers found that 7.7 percent of patients were taking warfarin. Those taking warfarin had higher crude rates of ICH (5.7 versus 4.7 percent; unadjusted odds ratio [OR], 1.22; 95 percent confidence interval [CI], 0.99 to 1.51), but after adjustment, the risk of ICH was similar for warfarin and non-warfarin users (adjusted OR, 1.01; 95 percent CI, 0.82 to 1.25). There were no significant differences for serious systemic hemorrhage, any tPA complications, and in-hospital mortality, between warfarin and non-warfarin users. Among warfarin users, those with higher baseline INR levels had a trend toward higher crude ICH rates. After adjustment for risk factors, the association between higher INR levels and ICH risk was only marginally significant (adjusted OR 1.10, 95 percent CI, 1.00 to 1.20; P = 0.06 for each 0.1 unit increase in INR).

"Our study suggests tPA is not associated with excessive bleeding or death among warfarin patients when used according to American Heart Association/American Stroke Association guidelines," Xian said in a statement. "tPA has been shown to minimize brain damage and disability from stroke and should not be withheld from these patients."

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