Anticoagulants raise hemorrhage risk post stroke--study

Researchers at the Rush University Medical Center, Chicago have found that the intravenous tissue plasminogen activator (tPA), a clot-dissolving drug results in brain hemorrhage in people taking it regularly.

But it is also helpful in ischemic strokes by bringing about better medical results, more often, added the researchers.

Lead researcher Dr. Shyam Prabhakaran, assistant professor, neurological sciences and head of the stroke program at Rush University Medical Center said, “I think we have raised a doubt that hasn’t been looked at before and should make us be sure that tPA is safe for these patients before we move forward.”

Dr. Ralph Sacco, professor and chairman of neurology, University of Miami Miller School of Medicine and president of the American Heart Association said, “This is an important study that talks about the risks we are well aware of when we use tPA for ischemic strokes.”

107 people studied
The research team examined 107 patients, aged 69, who were suffering from severe ischemic stroke and treated with tPA between the years 2002 and 2009.

Of the total number of subjects, 13 were taking the anticoagulant coumadin, also called warfarin, prior to a stroke.

After analysis, it was revealed that the occurrence of excessive internal bleeding in subjects taking the drug was 30.2 percent.

On the other hand, subjects who did not take warfarin had a meager hemorrhage rate of 3.2 percent.

The study also revealed that previously, the instances of occurrence of symptomatic intra-cerebral hemorrhage were 6.5 percent in general.

However, it escalated 10 times with subjects taking warfarin, in contrast to non-takers.

“Baseline warfarin use remained strongly associated with symptomatic intra-cerebral hemorrhage after adjusting for relevant co-variates, including age, atrial fibrillation, National institutes of Health Stroke Scale score and international normalized ratio,” established the researchers.

Further research required
“It is a single-center, retrospective study and not large enough so that it could be affected by sample size. We need a larger data set from more centers,” said Prabhakaran.

Sacco stated, “This is a non-randomized study. All case studies always raise concerns about some bias.”

Researchers stated that most aged Americans take Coumadin to avert problems attributable to atrial fibrillation, abnormality in heart rhythm, and also to prevent clotting in artificial heart valves.

The study appears in the Archives of Neurology.