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Modifiable risk factors for intracerebral hemorrhage

Study of anticoagulated patients

Mohammed F. Shamji, MSc MD
Fourth-year resident in neurosurgery at the Ottawa Hospital in Ontario and a doctoral candidate in biomedical engineering at Duke University

James Cole, MBA AIT
Works for Dell Inc in Ottawa

Brien G. Benoit, MA MD FRCSC FACS
Staff neurosurgeon and former Chief and Program Director of Neurosurgery at the Ottawa Hospital, and former Chief of Surgery at the Ottawa Civic Hospital

Correspondence to: Dr Elana C. Fric-Shamji, 1416-2616 Erwin Rd, Durham, NC 27705, USA; telephone 919 383-5035; e-mailefric{at}alumni.uottawa.ca

OBJECTIVE To determine whether there are modifiable risk factors for spontaneous intracerebral hemorrhage in patients receiving oral anticoagulation (OAC) therapy.

DESIGN Retrospective chart review between January 2002 and December 2004.

PARTICIPANTS A total of 315 consecutive patients presenting with spontaneous intracerebral hemorrhage.

MAIN OUTCOME MEASURES Overall mortality rates and surgical mortality rates, and discharge home compared with discharge to a long-term care facility.

RESULTS Of the 315 patients reviewed, 65 (20.6%) were receiving OAC therapy. Age, Glasgow Coma Scale score, and size of hematoma at presentation were similar in the 65 patients taking OAC and the 250 patients not taking it. Mean arterial pressure at presentation was significantly higher in the OAC group than in the control group (132 mm Hg vs 107 mm Hg, P = .01) as was the number of hematomas that progressed (52% vs 14%, P = .01). Overall mortality rates were higher in the OAC group than in the control group (52% vs 41%, P = .03) as were surgical mortality rates (62% vs 41%, P = .04). There were no significant differences in morbidity between the 2 groups.

CONCLUSION Mortality rates were higher among patients taking OAC therapy despite their having similarly sized hematomas at presentation. The higher initial mean arterial pressure among such patients has not been described previously in this setting. This higher mean arterial pressure correlates with the propensity of these patients’ hematomas to expand after initial imaging and might partially mediate the mortality effect. In patients taking OAC, hypertension appears to be a modifiable risk factor for morbidity and mortality from intracerebral hemorrhage.