Kuramatsu, Joji B., Sembill, Jochen A. ORCID: 0000-0003-0014-3389, Gerner, Stefan T., Spruegel, Maximilian I., Hagen, Manuel, Roeder, Sebastian S., Endres, Matthias, Haeusler, Karl Georg, Sobesky, Jan, Schurig, Johannes, Zweynert, Sarah, Bauer, Miriam, Vajkoczy, Peter, Ringleb, Peter A., Purrucker, Jan, Rizos, Timolaos, Volkmann, Jens, Muellges, Wolfgang, Kraft, Peter, Schubert, Anna-Lena, Erbguth, Frank, Nueckel, Martin, Schellinger, Peter D., Glahn, Joerg, Knappe, Ulrich J., Fink, Gereon R., Dohmen, Christian, Stetefeld, Henning, Fisse, Anna Lena ORCID: 0000-0003-0493-8656, Minnerup, Jens, Hagemann, Georg, Rakers, Florian, Reichmann, Heinz, Schneider, Hauke ORCID: 0000-0002-9641-0922, Woepking, Sigrid, Ludolph, Albert Christian, Stoesser, Sebastian, Neugebauer, Hermann ORCID: 0000-0003-3759-356X, Roether, Joachim, Michels, Peter, Schwarz, Michael, Reimann, Gernot, Baezner, Hansjoerg, Schwert, Henning, Classen, Joseph ORCID: 0000-0001-7182-6967, Michalski, Dominik, Grau, Armin, Palm, Frederick, Urbanek, Christian, Woehrle, Johannes C., Alshammari, Fahid, Horn, Markus, Bahner, Dirk, Witte, Otto W., Guenther, Albrecht, Hamann, Gerhard F., Luecking, Hannes, Doerfler, Arnd, Achenbach, Stephan, Schwab, Stefan and Huttner, Hagen B. (2018). Management of therapeutic anticoagulation in patients with intracerebral haemorrhage andmechanical heart valves. Eur. Heart J., 39 (19). S. 1709 - 1724. OXFORD: OXFORD UNIV PRESS. ISSN 1522-9645

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Abstract

Aims Evidence is lacking regarding acute anticoagulation management in patients after intracerebral haemorrhage (ICH) with implanted mechanical heart valves (MHVs). Our objective was to investigate anticoagulation reversal and resumption strategies by evaluating incidences of haemorrhagic and thromboembolic complications, thereby defining an optimal time-window when to restart therapeutic anticoagulation (TA) in patients with MHV and ICH. Methods and results We pooled individual patient- data (n = 2504) from a nationwide multicentre cohort-study (RETRACE, conducted at 22 German centres) and eventually identified MHV-patients (n = 137) with anticoagulation-associated ICH for outcome analyses. The primary outcome consisted of major haemorrhagic complications analysed during hospital stay according to treatment exposure (restarted TA vs. no-TA). Secondary outcomes comprised thromboembolic complications, the composite outcome (haemorrhagic and thromboembolic complications), timing of TA, and mortality. Adjusted analyses involved propensity-score matching and multivariable cox-regressions to identify optimal timing of TA. In 66/137 (48%) of patients TA was restarted, being associated with increased haemorrhagic (TA = 17/66 (26%) vs. no-TA = 4/71 (6%); P < 0.01) and a trend to decreased thromboembolic complications (TA = 1/66 (2%) vs. no-TA = 7/71 (10%); P = 0.06). Controlling treatment crossovers provided an incidence rate-ratio [hazard ratio (HR) 10.31, 95% confidence interval (CI) 3.67-35.70; P < 0.01] in disadvantage of TA for haemorrhagic complications. Analyses of TA-timing displayed significant harm until Day 13 after ICH (HR 7.06, 95% CI 2.33-21.37; P < 0.01). The hazard for the composite-balancing both complications, was increased for restarted TA until Day 6 (HR 2.51, 95% CI 1.10-5.70; P = 0.03). Conclusion Restarting TA within less than 2 weeks after ICH in patients with MHV was associated with increased haemorrhagic complications. Optimal weighing-between least risks for thromboembolic and haemorrhagic complications-provided an earliest starting point of TA at Day 6, reserved only for patients at high thromboembolic risk.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Kuramatsu, Joji B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sembill, Jochen A.UNSPECIFIEDorcid.org/0000-0003-0014-3389UNSPECIFIED
Gerner, Stefan T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Spruegel, Maximilian I.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hagen, ManuelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Roeder, Sebastian S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Endres, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Haeusler, Karl GeorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sobesky, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schurig, JohannesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zweynert, SarahUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bauer, MiriamUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vajkoczy, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ringleb, Peter A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Purrucker, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rizos, TimolaosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Volkmann, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Muellges, WolfgangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kraft, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schubert, Anna-LenaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Erbguth, FrankUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nueckel, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schellinger, Peter D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Glahn, JoergUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Knappe, Ulrich J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fink, Gereon R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dohmen, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stetefeld, HenningUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fisse, Anna LenaUNSPECIFIEDorcid.org/0000-0003-0493-8656UNSPECIFIED
Minnerup, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hagemann, GeorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rakers, FlorianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reichmann, HeinzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schneider, HaukeUNSPECIFIEDorcid.org/0000-0002-9641-0922UNSPECIFIED
Woepking, SigridUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ludolph, Albert ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stoesser, SebastianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Neugebauer, HermannUNSPECIFIEDorcid.org/0000-0003-3759-356XUNSPECIFIED
Roether, JoachimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Michels, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwarz, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reimann, GernotUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baezner, HansjoergUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwert, HenningUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Classen, JosephUNSPECIFIEDorcid.org/0000-0001-7182-6967UNSPECIFIED
Michalski, DominikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Grau, ArminUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Palm, FrederickUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Urbanek, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Woehrle, Johannes C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Alshammari, FahidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Horn, MarkusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bahner, DirkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Witte, Otto W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guenther, AlbrechtUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hamann, Gerhard F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Luecking, HannesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Doerfler, ArndUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Achenbach, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwab, StefanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Huttner, Hagen B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-186451
DOI: 10.1093/eurheartj/ehy056
Journal or Publication Title: Eur. Heart J.
Volume: 39
Number: 19
Page Range: S. 1709 - 1724
Date: 2018
Publisher: OXFORD UNIV PRESS
Place of Publication: OXFORD
ISSN: 1522-9645
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
INTRACRANIAL HEMORRHAGE; ATRIAL-FIBRILLATION; EUROPEAN-SOCIETY; TASK-FORCE; CARDIOLOGY ESC; ICH SCORE; REPLACEMENT; GUIDELINES; THROMBOSIS; DISEASEMultiple languages
Cardiac & Cardiovascular SystemsMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/18645

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