Intracranial hemorrhage, factors

Factors that increase the risk of bleeding must be evaluated before thrombolytic therapy is initiated (i.e., recent surgery, trauma or internal bleeding, uncontrolled hypertension, recent stroke, or intracranial hemorrhage)... 

Normal range of factor VIII/IX activity level is 0.5-1.5 units/mL (50%—1 50%). 1 unit/mL corresponds to 1 00% of the factor found in 1 mL of normal plasma. CNS, central nervous system ICH, intracranial hemorrhage PCB, postcircumceisional bleeding. 

Bleeding episodes Pis Onset Few weeks Symptoms TSpontaneous bleeding tendency (in joints, muscles, soft tissues, and hematuria) PI use in hemophiliac patients TPV and anticoagulants (risk of intracranial hemorrhage) Consider using a NNRTI-based regimen May require increased use of factor VIII products... 

Hetastarch 6% has comparable plasma expansion to 5% albumin solution but is usually less expensive, which accounts for much of its use. Hetastarch should be avoided in situations in which short-term impairments in hemostasis could have adverse consequences (e.g., cardiopulmonary bypass surgery, intracranial hemorrhage), because it may aggravate bleeding due to mechanisms such as decreased factor VIII activity. 

Hylek EM, Singer DE. Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med I994 I20(II) 897-902. 

Boulis NM, Bobek MP, Schmaier A, Hoff JT. Use of factor IX complex in warfarin-related intracranial hemorrhage. Neurosurgery 1999 45(5) 1113-19. 

The susceptibility factors for intracranial hemorrhage have also been examined (10). The main factors were ... 

Factor concentrate therapy may be necessary if the patient requires further treatment. Factor levels should be measured to ensure that an adequate response has been achieved. Treatment with desmopressin will not result in hemostasis for patients who have severe hemophilia and for those who are only marginally responsive. Also, it should not be used as primary therapy for life-threatening bleeding episodes such as intracranial hemorrhage or for major surgical procedures when a minimum factor VIE concentration of 0.7 to 1 unit/mL is required. ... 

Table 9.1 Factors Associated with Intracranial Hemorrhage Based on Multiple Logistic Regression...

Adjusted odds ratios were derived from a multiple logistic regression analysis in which each odds ratio was adjusted for all other factors listed. An odds ratio higher than 1 indicates that patients with the characteristic have a higher likelihood of having an intracranial hemorrhage than those without the characteristic. 

Intracranial hemorrhage is the most common clinical presentation of brain AVM, with a frequency of between 30% and 82% (Mast et al. 1995). Identification of factors increasing the risk of bleeding of a brain AVM is very important with regard to the treatment strategy. However, two difficulties are encountered in an analysis of the literature ... 

This factor was defined as transdural anastomosis or secondarily acquired perilesional angiogenesis (Mansmann et al. 2000). When it is combined with arterial stenosis or dural venous stenosis, this factor may increase the risk of intracranial hemorrhage. 

The presence of a stenosis on the venous drainage of a brain AVM is associated with an increased risk of bleeding (Miyasaka et al. 1992 Nataf et al. 1997), probably due to proximal venous hypertension. This factor was also identified in the large series of patients analyzed by Mansmann et al. (2000), but venous stenosis was not statistically associated with intracranial hemorrhage for cortical AVMs. Venous dilatation was correlated to an increased risk of hemorrhagic presentation in dural arteriovenous fistulas (CoGNARD et al. 1995). 

Switzer JA, Rocker J, Mohorn P, Waller JL, Hughes D, Bruno A, et al. Clinical experience with three-factor prothrombin complex concentrate to reverse warfarin anticoagulation in intracranial hemorrhage. Stroke 2012 43(9) 2500-2. 

---