title: Antithrombotic Treatment Following Intracerebral Hemorrhage in Patients With and Without Atrial Fibrillation.
abstract: OBJECTIVE
  Patients who survive intracerebral hemorrhage (ICH) often have compelling indications for anticoagulant and antiplatelet medication. This nationwide observational study aimed to determine the extent and predictors of antithrombotic treatment after ICH in Sweden.
  
  
  METHODS
  Patients with a first-ever ICH in the Swedish Stroke Register (Riksstroke) 2005 to 2012 who survived hospital discharge were included. Riksstroke data were individually linked with other national registers to determine comorbid conditions and dispensed prescriptions of antithrombotic agents.
  
  
  RESULTS
  Among the 2777 patients with atrial fibrillation (AF), the proportion with a dispensed prescription of antithrombotic agents was 8.5% (anticoagulants) and 36.6% (antiplatelet agents) within 6 months and 11.1% (anticoagulants) and 43.6% (antiplatelet agents) within 1 year. Among the 11 268 patients without AF, the corresponding figures were 1.6% (anticoagulants) and 13.8% (antiplatelet agents) within 6 months and 2.0% (anticoagulants) and 17.5% (antiplatelet agents) within 1 year. In patients with AF, predictors of anticoagulant treatment were less severe ICH, younger age, previous anticoagulation, valvular disease, and previous ischemic stroke. High CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke [doubled], vascular disease, age, and sex category [female]) scores did not correlate with anticoagulant treatment. There was a positive correlation between high CHA2DS2-VASc and HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol) scores (rs=0.590, P<0.001).
  
  
  CONCLUSIONS
  In majority of patients who receive antithrombotic agents, treatment is initiated within 6 months of ICH. Still, many patients with compelling indications for antithrombotic treatment are not prescribed antithrombotic agents. Factors other than high risk of embolic stroke by CHA2DS2-VASc in ICH survivors with concurrent AF are used to guide the anticoagulant treatment decision in Swedish clinical practice.
authors.affiliation: From the Department of Public Health and Clinical Medicine and Department of Medicine (J.P., K.A., B.C., P.-G.W.), Department of Community Medicine and Rehabilitation, Geriatric Medicine, Sunderby Research Unit (A.W.), and Department of Statistics, Umeå School of Business and Economics (M.E.), Umeå University, Sweden; and Department of Medical Sciences, Uppsala University, Sweden (S.Å.). johanna.pennlert@vll.se.
authors.forename: Johanna
authors.initials: J
authors.lastname: Pennlert
authors.affiliation: From the Department of Public Health and Clinical Medicine and Department of Medicine (J.P., K.A., B.C., P.-G.W.), Department of Community Medicine and Rehabilitation, Geriatric Medicine, Sunderby Research Unit (A.W.), and Department of Statistics, Umeå School of Business and Economics (M.E.), Umeå University, Sweden; and Department of Medical Sciences, Uppsala University, Sweden (S.Å.).
authors.forename: Kjell
authors.initials: K
authors.lastname: Asplund
authors.affiliation: From the Department of Public Health and Clinical Medicine and Department of Medicine (J.P., K.A., B.C., P.-G.W.), Department of Community Medicine and Rehabilitation, Geriatric Medicine, Sunderby Research Unit (A.W.), and Department of Statistics, Umeå School of Business and Economics (M.E.), Umeå University, Sweden; and Department of Medical Sciences, Uppsala University, Sweden (S.Å.).
authors.forename: Bo
authors.initials: B
authors.lastname: Carlberg
authors.affiliation: From the Department of Public Health and Clinical Medicine and Department of Medicine (J.P., K.A., B.C., P.-G.W.), Department of Community Medicine and Rehabilitation, Geriatric Medicine, Sunderby Research Unit (A.W.), and Department of Statistics, Umeå School of Business and Economics (M.E.), Umeå University, Sweden; and Department of Medical Sciences, Uppsala University, Sweden (S.Å.).
authors.forename: Per-Gunnar
authors.initials: PG
authors.lastname: Wiklund
authors.affiliation: From the Department of Public Health and Clinical Medicine and Department of Medicine (J.P., K.A., B.C., P.-G.W.), Department of Community Medicine and Rehabilitation, Geriatric Medicine, Sunderby Research Unit (A.W.), and Department of Statistics, Umeå School of Business and Economics (M.E.), Umeå University, Sweden; and Department of Medical Sciences, Uppsala University, Sweden (S.Å.).
authors.forename: Aase
authors.initials: A
authors.lastname: Wisten
authors.affiliation: From the Department of Public Health and Clinical Medicine and Department of Medicine (J.P., K.A., B.C., P.-G.W.), Department of Community Medicine and Rehabilitation, Geriatric Medicine, Sunderby Research Unit (A.W.), and Department of Statistics, Umeå School of Business and Economics (M.E.), Umeå University, Sweden; and Department of Medical Sciences, Uppsala University, Sweden (S.Å.).
authors.forename: Signild
authors.initials: S
authors.lastname: Åsberg
authors.affiliation: From the Department of Public Health and Clinical Medicine and Department of Medicine (J.P., K.A., B.C., P.-G.W.), Department of Community Medicine and Rehabilitation, Geriatric Medicine, Sunderby Research Unit (A.W.), and Department of Statistics, Umeå School of Business and Economics (M.E.), Umeå University, Sweden; and Department of Medical Sciences, Uppsala University, Sweden (S.Å.).
authors.forename: Marie
authors.initials: M
authors.lastname: Eriksson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents
keywords: anticoagulation; antiplatelet agent; atrial fibrillation; intracerebral hemorrhage