Neurocritical Care

, Volume 12, Issue 1, pp 30–34

Comparison of Hematoma Shape and Volume Estimates in Warfarin Versus Non-Warfarin-Related Intracerebral Hemorrhage

  • Kevin N. Sheth
  • Tracy A. Cushing
  • Lauren Wendell
  • Michael H. Lev
  • Javier M. Romero
  • Kristin Schwab
  • Eric E. Smith
  • Steven M. Greenberg
  • Jonathan Rosand
  • Joshua N. Goldstein
Original Article

Abstract

Background

Hematoma volume is a major determinant of outcome in patients with intracerebral hemorrhage (ICH). Accurate volume measurements are critical for predicting outcome and are thought to be more difficult in patients with oral anticoagulation-related ICH (OAT-ICH) due to a higher frequency of irregular shape. We examined hematoma shape and methods of volume assessment in patients with OAT-ICH.

Methods

We performed a case–control analysis of a prospectively identified cohort of consecutive patients with ICH. We retrospectively reviewed 50 consecutive patients with OAT-ICH and 50 location-matched non-OAT-ICH controls. Two independent readers analyzed CT scans for hematoma shape and volume using both ABC/2 and ABC/3 methods. Readers were blinded to all clinical variables including warfarin status. Gold-standard ICH volumes were determined using validated computer-assisted planimetry.

Results

Within this cohort, median INR in patients with OAT-ICH was 3.2. Initial ICH volume was not significantly different between non-OAT-ICH and OAT-ICH (35 ± 38 cc vs. 53 ± 56 cc, P = 0.4). ICH shape did not differ by anticoagulation status (round shape in 10% of OAT-ICH vs. 16% of non-OAT-ICH, P = 0.5). The ABC/3 calculation underestimated median volume by 9 (3–28) cc, while the ABC/2 calculation did so by 4 (0.8–12) cc.

Conclusions

Hematoma shape was not statistically significantly different in patients with OAT-ICH. Among bedside approaches, the standard ABC/2 method offers reasonable approximation of hematoma volume in OAT-ICH and non-OAT-ICH.

Keywords

Cerebral hemorrhage Tomography X-ray computed Warfarin 

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Copyright information

© Humana Press Inc. 2009

Authors and Affiliations

  • Kevin N. Sheth
    • 1
  • Tracy A. Cushing
    • 3
  • Lauren Wendell
    • 2
  • Michael H. Lev
    • 4
  • Javier M. Romero
    • 4
  • Kristin Schwab
    • 2
  • Eric E. Smith
    • 5
  • Steven M. Greenberg
    • 2
  • Jonathan Rosand
    • 2
    • 5
  • Joshua N. Goldstein
    • 6
  1. 1.Division of NeurologyUniversity of Maryland Medical CenterBaltimoreUSA
  2. 2.Department of NeurologyMassachusetts General HospitalBostonUSA
  3. 3.Department of Emergency MedicineMt. Auburn HospitalBostonUSA
  4. 4.Department of RadiologyMassachusetts General HospitalBostonUSA
  5. 5.The Calgary Stroke Program, Department of Clinical NeurosciencesUniversity of CalgaryCalgaryCanada
  6. 6.Department of Emergency MedicineMassachusetts General HospitalBostonUSA

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