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

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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.

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Acknowledgments

Funding was provided by The National Institute of Neurological Disorders and Stroke (NIH R01 NS059727 and K23NS059774), American Heart Association Grant-in-Aid #0755984T, and the Deane Institute for Integrative Study of Atrial Fibrillation and Stroke.

Conflicts of Interest Disclosure

Dr. Goldstein has received consulting fees from CSL Behring and Genentech.

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Authors and Affiliations

  1. Division of Neurology, University of Maryland Medical Center, Baltimore, MD, USA

    Kevin N. Sheth

  2. Department of Neurology, Massachusetts General Hospital, Boston, MA, USA

    Lauren Wendell, Kristin Schwab, Steven M. Greenberg & Jonathan Rosand

  3. Department of Emergency Medicine, Mt. Auburn Hospital, Boston, MA, USA

    Tracy A. Cushing

  4. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Michael H. Lev & Javier M. Romero

  5. The Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada

    Eric E. Smith & Jonathan Rosand

  6. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA

    Joshua N. Goldstein

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  1. Kevin N. Sheth
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  2. Tracy A. Cushing
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  3. Lauren Wendell
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  4. Michael H. Lev
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  5. Javier M. Romero
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  6. Kristin Schwab
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  7. Eric E. Smith
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  8. Steven M. Greenberg
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  9. Jonathan Rosand
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  10. Joshua N. Goldstein
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Correspondence to Kevin N. Sheth.

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Sheth, K.N., Cushing, T.A., Wendell, L. et al. Comparison of Hematoma Shape and Volume Estimates in Warfarin Versus Non-Warfarin-Related Intracerebral Hemorrhage. Neurocrit Care 12, 30–34 (2010). https://doi.org/10.1007/s12028-009-9296-7

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  • DOI: https://doi.org/10.1007/s12028-009-9296-7

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