title: Atrial fibrillation patients who sustained warfarin-associated intracerebral haemorrhage have poor neurological outcomes: results from a matched case series.
abstract: BACKGROUND
  Coagulopathy-associated intracerebral haemorrhage has become increasingly common because of the rising demand in the ageing population for anticoagulation for atrial fibrillation. This study compared the clinical features and neurological outcomes of intracerebral haemorrhage in patients with atrial fibrillation who were prescribed warfarin with those who were not.
  
  
  METHODS
  This was a retrospective matched case series of patients with intracerebral haemorrhage from three tertiary hospitals in Hong Kong from 1 January 2006 to 31 December 2011. Patients who developed intracerebral haemorrhage and who were prescribed warfarin for atrial fibrillation (ICH-W group) were compared with those with intracerebral haemorrhage and not prescribed warfarin (ICH-C group); they were matched for age and gender in 1:1 ratio. Clinical features and neurological outcomes were compared, and the impact of coagulopathy on haematoma size was also studied.
  
  
  RESULTS
  We identified 114 patients in the ICH-W group with a mean age of 75 years. Both ICH-W and ICH-C groups had a median intracerebral haemorrhage score of 2. There was a non-statistically significant trend of higher intracerebral haemorrhage volume in the ICH-W group (12.9 mL vs 10.5 mL). The median modified Rankin Scale and the proportion with good recovery (modified Rankin Scale score ≤3) at 6 months were comparable. Nonetheless, ICH-W patients had higher hospital mortality (51.8% vs 36.0%; P=0.02) and 6-month mortality (60.5% vs 43.0%; P=0.01) than ICH-C patients. Overall, 60% of ICH-W patients had their admission international normalised ratio within the therapeutic range during intracerebral haemorrhage, and 14% had a subtherapeutic admission international normalised ratio. International normalised ratio at admission was not associated with intracerebral haemorrhage volume or neurological outcome.
  
  
  CONCLUSIONS
  Warfarin-associated intracerebral haemorrhage in patients with atrial fibrillation carried a higher stroke mortality than the non-warfarinised patients.
authors.affiliation: Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Hong Kong.
authors.forename: M K
authors.initials: MK
authors.lastname: Fong
authors.affiliation: Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Hong Kong.
authors.forename: B
authors.initials: B
authors.lastname: Sheng
authors.affiliation: Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Hong Kong.
authors.forename: Y P
authors.initials: YP
authors.lastname: Chu
authors.affiliation: Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Hong Kong.
authors.forename: W T
authors.initials: WT
authors.lastname: Wong
authors.affiliation: Department of Rehabilitation, Kowloon Hospital, Argyle Street, Hong Kong.
authors.forename: P Pk
authors.initials: PP
authors.lastname: Lau
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Jordan, Hong Kong.
authors.forename: H Y
authors.initials: HY
authors.lastname: Wong
authors.affiliation: Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Hong Kong.
authors.forename: K K
authors.initials: KK
authors.lastname: Lau
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000401:mortality*; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Atrial fibrillation; Cerebral hemorrhage; Mortality; Neurological outcomes; Stroke; Warfarin