Anticoagulant associated stroke, an observational retrospective study in tertiary care hospital in north india

Introduction: Anticoagulant treatment is indicated for the treatment and prevention of recurrent thromboembolic disorders. Vitamin K antagonists are widely used oral anticoagulants worldwide. Vitamin K antagonists act by inhibition of vitamin K epoxide reductase and are often used for long-term anticoagulation. The benefits of oral anticoagulants have been clearly established in well-designed clinical trials. Coumarin preparations are commonly used vitamin K antagonists in clinical practice. Warfarin is the most widely used oral anticoagulant (OAC) in the world, although acenocoumarol, phenprocoumon or anisindione are also frequently prescribed in several countries. Nonetheless, OAC are also notorious for having a narrow therapeutic index, numerous drug and dietary interactions, and a significant risk of serious bleeding that includes hemorrhagic stroke.
Material and methods: This study was an observational retrospective study conducted at the Government medical college and SMHS over a period of 1yr.A detailed initial assessment of the patients was done, clinical indication for the use of anticoagulants and the duration of treatment was noted. An NCCT of the Brain was performed on admission to note the site and volume of bleed and intraventricular extension. Patients were followed for 30days with clinical, biochemical parameters and the outcome was noted. All statistical analysis was performed using SPSS version 21 for Windows (IBM). A P value < 0.05 was taken to be statistically significant.
Result: A total of 422 stroke patients were studied, out of which 224(53.08%) had ischemic and 198(46.91%) had hemorrhagic stroke. The age distribution shows mean age of patients with OAC-ICH was 61yrs. 56.25% of our patients were females and 43.75% were males. The mean duration of use of anticoagulants in our cohort was 2.2 yrs. out of 16, 6 patients were on acitrom, 9 on warfarin and 1 on dabigatran. All our patients had deranged coagulation parameters on admission with PT/INR >8. Sixteen patients (ie 0.04% of all strokes and 8.08% of all ICH) were associated with oral anticoagulant use (OAC-ICH).
Conclusion: oral anticoagulant associated ICH is a significant complication of these drugs and with the increasing use of these drugs in thromboembolic disorders, its incidence is only expected to rise.