title: Coagulopathy disproportionately predisposes to lobar intracerebral hemorrhage.
abstract: BACKGROUND
  Anticoagulation increases the risk of intracerebral hemorrhage (ICH), yet whether different underlying disease processes are equally affected is unknown. We tested the hypothesis that coagulopathy, measured by admission international normalized ratio (INR), disproportionately increases the risk for lobar hemorrhages.
  
  
  METHODS
  Patients with primary ICH were enrolled into a registry between December 2006 and February 2012 with prospective data acquisition and systematic follow up. Logistic regression was used to test whether lobar versus deep ICH location was independently associated with INR, and then whether INR had an influence on mortality. Spearman's correlation coefficient was used to test for an association between INR and hematoma volume separately in the lobar and deep ICH groups.
  
  
  RESULTS
  221 patients were studied. Patients with lobar ICH were older (71 vs. 62 years old, p < 0.001) and more likely to have prior ICH (10 vs. 0 %, p < 0.001). INR >1.4 was observed on admission more frequently in lobar versus deep ICH (19 vs. 8 %, p = 0.02). Lobar ICH location was independently associated with INR >1.4 (OR: 2.51, 95 % CI: 1.03-6.14, p = 0.043). ICH volume correlated with INR in lobar ICH (p = 0.009), but not deep ICH (p = 0.8). Death at 1 month was independently associated with INR >1.4 (OR: 7.6, 95 % CI: 2.4-24.1, p = 0.001) after correction for the ICH Score.
  
  
  CONCLUSIONS
  Abnormal coagulation occurs disproportionally in lobar versus deep ICH, and is associated with larger ICH volumes and higher mortality. These findings suggest a unique risk interaction between coagulopathy and underlying brain pathology due to cerebral amyloid angiopathy.
authors.affiliation: Department of Neurology, Northwestern University, 710 N Lake Shore Drive, Chicago, IL, 60611, USA. mbmaas@northwestern.edu
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Maas
authors.forename: Neil F
authors.initials: NF
authors.lastname: Rosenberg
authors.forename: Adam R
authors.initials: AR
authors.lastname: Kosteva
authors.forename: Shyam
authors.initials: S
authors.lastname: Prabhakaran
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Naidech
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001778:Blood Coagulation Disorders / Q000150:complications* / Q000175:diagnosis; D002540:Cerebral Cortex / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000097:blood / Q000401:mortality / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index