Pre-ICH warfarin use, not antiplatelets, increased case fatality in spontaneous ICH patients.
OBJECTIVE
Anticoagulant and antiplatelets for prevention of ischaemic stroke and cardiovascular diseases may increase the risk of intracerebral hemorrhage (ICH). This study aimed to investigate the influence of pre-ICH use of anticoagulant and antiplatelets on ICH patients.


METHODS
Consecutive patients with acute spontaneous ICH registered in a single-center stroke registry during 2001 to 2010 were analyzed and categorized according to their pre-ICH use of warfarin (Group I), antiplatelets (Group II), or neither (Group III). Survival analysis and the Cox proportional hazard model were used to compare between the three groups and the predictors.


RESULTS
Of 2021 ICH patients (male, 63.3%; mean age, 62.6 ± 14.4 years) included, there were 94 (4.7%) in Group I, 232 (11.4%) in Group II, and 1695 (83.9%) in Group III. Warfarin users had larger hematoma volume, more intraventricular extension, higher frequencies of lobar ICH, and higher case fatality than non-warfarin users (Groups II and III). The Cox proportional hazard model showed increased 6-month case fatality in pre-ICH warfarin users (adjusted hazard ratio 2.75, 95% confidence interval 2.04-3.72, P < 0.001), but not in pre-ICH antiplatelet users (adjusted hazard ratio 0.95, 95% confidence interval 0.72-1.26).


CONCLUSIONS
Intracerebral hemorrhage patients with prior warfarin use, but not antiplatelet use, had significantly higher case fatality at 6 months.
Department of Neurology, Landseed Hospital, Taoyuan, Taiwan.
Y-W
YW
Chen
S-C
SC
Tang
L-K
LK
Tsai
S-J
SJ
Yeh
H-Y
HY
Chiou
P-K
PK
Yip
J-S
JS
Jeng
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D019540:Area Under Curve; D002543:Cerebral Hemorrhage / Q000401:mortality* / Q000473:pathology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012372:ROC Curve; D012042:Registries; D020521:Stroke / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D014859:Warfarin / Q000009:adverse effects*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin