Restarting anticoagulation therapy after warfarin-associated intracerebral hemorrhage

Arch Neurol. 2008 Oct;65(10):1313-8. doi: 10.1001/archneur.65.10.1313.


Background: Reinitiating warfarin sodium therapy in a patient with a recent warfarin-related intracerebral hemorrhage (WAICH) is a difficult clinical decision. Therefore, it is important to assess the outcome of resumption or discontinuation of warfarin therapy after WAICH.

Objective: To compare patients who survived an episode of WAICH and restarted warfarin therapy with a group of WAICH patients who did not resume warfarin therapy. Design, Setting, and Patients We conducted a follow-up study from November 1, 2001, through December 31, 2005, in a cohort from a single center. Long-term outcome was assessed at last clinical follow-up or via questionnaire.

Main outcome measures: Recurrent WAICH and thromboembolic events.

Results: Fifty-two patients were discharged from the hospital after a diagnosis of WAICH. Four patients were lost to follow-up. Mean follow-up among all patients was 43 (range, 1-108) months. Of the 23 patients who restarted warfarin therapy, 1 had a recurrent nontraumatic WAICH, 2 had traumatic intracerebral hemorrhages, and 2 had major extracranial hemorrhages. Of the 25 patients who did not restart warfarin therapy, 3 had a thromboembolic stroke, 1 had a pulmonary embolus, and 1 had a distal arterial embolus.

Conclusions: Restarting warfarin therapy in patients with a recent WAICH is associated with a low risk of recurrence, but patients are subjected to known, substantial risks of warfarin use. Withholding warfarin therapy is associated with a risk of thromboembolization.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anticoagulants / administration & dosage
  • Anticoagulants / adverse effects*
  • Brain / blood supply
  • Brain / pathology
  • Brain / physiopathology
  • Cerebral Hemorrhage / chemically induced*
  • Cerebral Hemorrhage / mortality
  • Cerebral Hemorrhage / physiopathology
  • Clinical Protocols
  • Cohort Studies
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Mortality
  • Pulmonary Embolism / epidemiology
  • Retrospective Studies
  • Risk Assessment
  • Stroke / epidemiology
  • Time
  • Venous Thromboembolism / drug therapy*
  • Venous Thromboembolism / prevention & control
  • Warfarin / administration & dosage
  • Warfarin / adverse effects*


  • Anticoagulants
  • Warfarin