Location and outcome of anticoagulant-associated intracerebral hemorrhage.
BACKGROUND
The characteristics of patients with anticoagulant-associated intracerebral hemorrhage (AAICH) have not been well characterized in a population-based setting.


METHODS
We attempted to ascertain all patients with ICH in Greater Cincinnati from May 1998 to July 2001 and August 2002 to April 2003 via retrospective review of ICD-9 codes 430-438.9 at all area hospitals and prospective surveillance at tertiary centers. Cases of ICH without coagulopathy and AAICH were compared with multivariate logistic modeling and survival analysis.


RESULTS
AAICH occurred in 190 of 1041 ICH cases (18%). In multivariate analysis, predictors of AAICH were cerebellar location of hemorrhage (p = 0.01) and a history of coronary artery disease (p < 0.001), ischemic stroke (p < 0.001), atrial fibrillation (p < 0.001) and DVT or PE (p < 0.001). Relative to other ICH locations, only cerebellar ICH showed an excess risk of anticoagulant-associated hemorrhage (OR 2.2, 95% CI 1.2 to 4.0). In multivariate modeling the only predictor of cerebellar location of ICH was anticoagulation (p < 0.001). Patients with AAICH were more likely to die than other ICH patients. The difference in morality occurred by day one (mortality 33.2% vs 16.3%, p < 0.001) and remained stable through one year (mortality 66.3% vs 50.3%, p < 0.001).


CONCLUSIONS
AAICH preferentially affects the cerebellum. Despite its association with amyloid angiopathy, lobar ICH was no more likely to be anticoagulant-associated than deep cerebral ICH. The excess mortality among AAICH patients accrues within one day of hemorrhage. Patients with AAICH have a high burden of vascular risk factors. New treatments for AAICH with prothrombotic potential should be evaluated in randomized controlled trials before routine use.
Flaherty
Matthew L
ML
Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH 45267-0525, USA. matthew.flaherty@uc.edu
Haverbusch
Mary
M
Sekar
Padmini
P
Kissela
Brett M
BM
Kleindorfer
Dawn
D
Moomaw
Charles J
CJ
Broderick
Joseph P
JP
Woo
Daniel
D
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000150:complications; D002526:Cerebellar Diseases / Q000139:chemically induced / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000401:mortality; D002544:Cerebral Infarction / Q000150:complications; D003327:Coronary Disease / Q000150:complications; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011159:Population Surveillance; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014859:Warfarin / Q000009:adverse effects*
D000925:Anticoagulants; D014859:Warfarin