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This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 68, Number 2, January 09, 2007 Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Services Email this article to a friend Related articles in Neurology Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Cited by other online articles Google Scholar Articles by Flaherty, M. L. Articles by Broderick, J. P. PubMed PubMed Citation Articles by Flaherty, M. L. Articles by Broderick, J. P. Related Collections Hematologic All Cerebrovascular disease/Stroke Intracerebral hemorrhage

The increasing incidence of anticoagulant-associated intracerebral hemorrhage

From the Departments of Neurology (M.L.F., B.K., D.W., D.K., K.A., C.J.M., M.H., J.P.B.) and Environmental Health (P.S.), University of Cincinnati College of Medicine, OH.

Address correspondence and reprint requests to Dr. Matthew L. Flaherty, 231 Albert Sabin Way, MSB Room 5060, University of Cincinnati Medical Center, Cincinnati, OH 45267-0525; e-mail: matthew.flaherty@uc.edu

Objective: To define temporal trends in the incidence of anticoagulant-associated intracerebral hemorrhage (AAICH) during the 1990s and relate them to rates of cardioembolic ischemic stroke.

Methods: We identified all patients hospitalized with first-ever intracerebral hemorrhage (ICH) in greater Cincinnati during 1988, from July 1993 through June 1994, and during 1999. AAICH was defined as ICH in patients receiving warfarin or heparin. Patients from the same region hospitalized with first-ever ischemic stroke of cardioembolic mechanism were identified during 1993/1994 and 1999. Incidence rates were calculated and adjusted to the 2000 US population. Estimates of warfarin distribution in the United States were obtained for the years 1988 through 2004.

Results: AAICH occurred in 9 of 184 ICH cases (5%) in 1988, 23 of 267 cases (9%) in 1993/1994, and 54 of 311 cases (17%) in 1999 (p <> persons was 0.8 (95% CI 0.3 to 1.3) in 1988, 1.9 (1.1 to 2.7) in 1993/1994, and 4.4 (3.2 to 5.5) in 1999 (p <> trend). Among persons aged 80, the AAICH rate increased from 2.5 (0 to 7.4) in 1988 to 45.9 (25.6 to 66.2) in 1999 (p < 0.001 for trend). Incidence rates of cardioembolic ischemic stroke were similar in 1993/1994 and 1999 (31.1 vs 30.4, p = 0.65). Warfarin distribution in the United States quadrupled on a per-capita basis between 1988 and 1999.

Conclusions: The incidence of anticoagulant-associated intracerebral hemorrhage quintupled in our population during the 1990s. The majority of this change can be explained by increasing warfarin use. Anticoagulant-associated intracerebral hemorrhage now occurs at a frequency comparable to subarachnoid hemorrhage.

Supported in part by National Institute of Neurological Disorders and Stroke (R-01-NS 030678).

Disclosure: The authors report no conflicts of interest.

Received June 12, 2006. Accepted in final form September 28, 2006.

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