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|Risk of intracerebral hemorrhage in patients treated with warfarin |
|Robert G Hart, MD |
|Section Editors |
|Lawrence LK Leung, MD|
|Jose Biller, MD, FACP, FAAN, FAHA |
|Deputy Editor ||Stephen A Landaw, MD, PhD |
| |
|Last literature review for version 17.3: septembre 30, 2009  |  This topic last updated: février 6, 2009 |

INTRODUCTION — Antithrombotic therapies, including antiplatelet agents, heparin and related agents, oral vitamin K inhibitors, and direct thrombin inhibitors, are widely used in clinical medicine based upon well-designed randomizedclinical trials that have rigorously defined their benefits relative to associated bleeding risks. In most of these trials, patients presumed to be at especially high risk for intracerebral hemorrhage (ICH) were excluded from participation, in large part because the benefits were yet to be fully defined and the risks appeared unduly high.
Because of under-representation in clinical trials,determining the relative efficacy and safety of antithrombotic agents in patients at varying increased risks for ICH is problematic. Nevertheless, clinicians are regularly faced with risk/benefit decisions regarding antithrombotic therapy for such patients. (See "Antithrombotic therapy to prevent embolization in nonvalvular atrial fibrillation".)
The risk of intracerebral hemorrhage in patients treatedwith warfarin will be reviewed here. The management of warfarin- associated intracerebral hemorrhage is discussed separately. (See "Management of warfarin-associated intracerebral hemorrhage".)
There are a number of other settings in which anticoagulant or antiplatelet therapy might be considered for the prevention of thromboembolism, although in the presence of a co-morbid condition placing thepatient at considerable risk of bleeding (eg, intracranial aneurysm, brain tumor, prior intracerebral hemorrhage). These important, highly complex issues are discussed separately and include patients with the following:
• An unruptured intracranial aneurysm. (See "Anticoagulant and antiplatelet therapy in patients with an unruptured intracranial aneurysm".)
• An acute or prior ICH. (See"Anticoagulant and antiplatelet therapy in patients with an acute or prior intracerebral hemorrhage".)
• An increased risk for ocular hemorrhage. (See "Anticoagulant, antiplatelet, and fibrinolytic (thrombolytic) therapy in patients at high risk for ocular hemorrhage".)
• A primary or metastatic brain tumor. (See "Anticoagulant and antiplatelet therapy in patients with brain tumors".)...