Abstract

GARCIA LUQUE, A.; TORELLO ISERTE, J.  and  CASTILLO FERRANDO, J.R.. Avoidable intracranial hemorrhages associated with oral anticoagulants in patients with atrial fibrillation. Sanid. Mil. [online]. 2011, vol.67, n.4, pp.354-360. ISSN 1887-8571.  https://dx.doi.org/10.4321/S1887-85712011000500004.

Introduction and objectives: The increase in oral anticoagulants prescription has caused an increase in intracranial hemorrhages, the most adverse reaction to this pharmacological group. The objective of this study is to evaluate the avoidability of the intracranial hemorrhages associated with oral anticoagulants that require hospitalization of patients with atrial fibrillation. Methods: Survey of the medical histories of the patients who were hospitalized in the University Hospital "Virgen del Rocío" (from 01/01/03 to 03/31/07) with intracranial hemorrhages and atrial fibrillation, considering as intracranial hemorrhages associated with oral anticoagulants those with a probable relationship applying the causality algorithm of the Spanish Pharmacological Surveillance System. In order to evaluate the avoidability of the intracranial hemorrhage the risk/benefit ratio of the use of oral anticoagulants has been studied. Results: At least 20 out of 57 (35.1%) intracranial hemorrhages associated with oral anticoagulants were potentially avoidable, in 7 cases out of those 20 (35 %) death was the outcome, and in 8 out of the remaining 13 (61.5%) the survivors suffered after-effects. Omeprazole was the drug more frequently involved in interactions with oral anticoagulants in 11 out of 57 cases (19%) although this interaction is categorized as highly probable in the bibliography and the protocols of the Hospital. Conclusions: The risk / benefit ratio of oral anticoagulants, the strict control of the International Normalized Ratio and the possible drug interactions, must be assessed individually and regularly to minimize the risk of intracranial hemorrhage that is often a potentially avoidable lethal adverse event.

Keywords : Anticoagulants; Intracranial hemorrhages; Atrial fibrillation.

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