title: Epidemiology of Intracranial Haemorrhages Associated with Vitamin K Antagonist Oral Anticoagulants in Spain: TAC Registry.
abstract: BACKGROUND
  Vitamin K antagonist oral anticoagulants (VKA-OACs) are effective for primary and secondary prevention of embolic events. The rate of haemorrhagic neurological complications in patients admitted to neurology departments in Spain is not yet known.
  
  
  OBJECTIVE
  We aimed to determine the clinical and epidemiological characteristics of patients with intracranial haemorrhage secondary to VKA-OACs as well as the incidence of this severe complication.
  
  
  METHODS
  We conducted a retrospective, descriptive, multi-centre study using information from the medical records of all patients admitted to neurology departments, diagnosed with spontaneous intracranial haemorrhage, and treated with VKA-OACs within a 1-year period. We collected demographic and care data from centres, patients' medical records [demographic data, medical history, haemorrhage origin, vascular risk factors, concomitant treatment, and National Institutes of Health Stroke Scale (NIHSS) scores], and patients' outcome at 3 months [independence (modified Rankin Scale score <3) and mortality rate].
  
  
  RESULTS
  Twenty-one hospitals serving a population of 8,155,628 inhabitants participated in the study. The total number of cases was 235, the mean age was 78.2 (SD 9.4) years, and the baseline NIHSS score was 11.6 (SD 9.5; median 9; interquartile range 14). The VKA-OACs used were acenocoumarol in 95.3% (224 patients) and warfarin in 4.7% (11 patients). The haemorrhage origin was deep in 29.8%, lobar in 25.5%, intraventricular in 11.5%, extensive in 17.4% (>100 ml), cerebellar in 12.3%, and in the brainstem in 3.4%. The international normalised ratio was within therapeutic ranges at admission (according to indication) in 29.4% (69 patients). The global incidence (cases per 100,000 inhabitants per year) is 2.88. The in-hospital mortality rate was 40%, and 24.3% of the patients were independent at 3 months, while the mortality at 3 months was 42.6%.
  
  
  CONCLUSIONS
  VKA-OAC treatment is associated with a large percentage of all cases of spontaneous intracranial haemorrhage, an event leading to high dependence and mortality rates.
authors.affiliation: Neurology Department at Hospital Universitario de La Princesa, Spain ; Neurology Department at Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Zapata-Wainberg
authors.affiliation: Neurology Department at Hospital Universitario de La Princesa, Spain ; Neurology Department at Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Ximénez-Carrillo Rico
authors.affiliation: Neurology Department at Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: Benavente Fernández
authors.affiliation: Neurology Department at Hospital Universitario Ramón y Cajal, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Masjuan Vallejo
authors.affiliation: Neurology Department at Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Gállego Culleré
authors.affiliation: Neurology Department at Hospital Universitario Basurto, Bilbao, Spain.
authors.forename: María Del Mar
authors.initials: Mdel M
authors.lastname: Freijó Guerrero
authors.affiliation: Neurology Department at Hospital Universitario Clínico San Carlos, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Egido
authors.affiliation: Neurology Department at Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Gómez Sánchez
authors.affiliation: Neurology Department at Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Martínez Domeño
authors.affiliation: Neurology Department at Hospital Universitari Arnau de Vilanova, Lleida, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Purroy García
authors.affiliation: Neurology Department at Hospital Universitari Son Espases, Majorca, Spain.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Vives Pastor
authors.affiliation: Neurology Department at Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Blanco González
authors.affiliation: Neurology Department at Hospital Universitario de La Princesa, Spain ; Neurology Department at Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Vivancos
keywords: Incidence; Intracranial haemorrhage; Neuroepidemiology ; Oral anticoagulants; Vitamin K antagonists