LAUSR

OBJECTIVES While warfarin use and the presence of the spot sign on computed tomography angiography are associated with a high frequency of hematoma enlargement and high mortality among patients with intracerebral hematomas (ICHs), the effects of various combinations of warfarin use and/or the spot sign have never been clarified. The combinations of both or either of warfarin use and/or the spot sign were used to investigate their relationships with hematoma enlargement and mortality before the introduction of prothrombin complex concentrate (PCC) treatment. PATIENTS AND METHODS Consecutive patients with ICHs admitted within 6 h of onset from 2009 to 2017 were investigated. RESULTS Of 703 eligible patients, the combinations of warfarin use and spot sign-present and of warfarin use and spot sign-absent were seen in 23 (3.3%) and 35 patients (5.0%), respectively. The combination of warfarin use and spot sign-present was a predictor of hematoma enlargement (p < 0.05). In regard to mortality (13.5% for all patients), mortality with the combination of warfarin use and spot sign-present was 52.2%, which was significantly higher than in the 3 other groups. Multivariate analysis showed that the combination of warfarin use and spot sign-present was a significant predictor of mortality (p < 0.05). CONCLUSION Warfarin users with ICHs showing spot signs, who accounted for approximately 40% of ICH patients with warfarin use, showed a high frequency of hematoma enlargement and high mortality. This group was regarded as high-risk patients and should be considered candidates for prompt administration of PCC.