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Updated: Jul 17, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Location and outcome of anticoagulant-associated intracerebral hemorrhage
Matthew L Flaherty1, Mary Haverbusch, Padmini Sekar
1Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH 45267-0525, USA. matthew.flaherty@uc.edu
Insights
Anticoagulant-associated intracerebral hemorrhage (AAICH) primarily impacts the cerebellum and is linked to higher mortality within the first day. Patients with AAICH exhibit numerous vascular risk factors.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Anticoagulant-associated intracerebral hemorrhage (AAICH) characteristics are not well-defined in population-based studies.
- Understanding AAICH patient profiles is crucial for improving outcomes.
Purpose of the Study:
- To characterize patients with AAICH in a large population-based setting.
- To identify predictors and outcomes of AAICH compared to other forms of intracerebral hemorrhage (ICH).
Main Methods:
- Retrospective and prospective surveillance of all intracerebral hemorrhage (ICH) cases in Greater Cincinnati (1998-2003).
- Comparison of AAICH cases with non-coagulopathic ICH using multivariate logistic modeling and survival analysis.
Main Results:
- AAICH accounted for 18% of ICH cases.
- Predictors of AAICH included cerebellar hemorrhage location and history of coronary artery disease, ischemic stroke, atrial fibrillation, and DVT/PE.
- Cerebellar ICH showed an increased risk of AAICH (OR 2.2).
- AAICH patients had significantly higher mortality rates, with excess deaths occurring within the first day and persisting through one year.
Conclusions:
- AAICH preferentially affects the cerebellum and is associated with a high burden of vascular risk factors.
- Excess mortality in AAICH patients accrues rapidly, within one day of hemorrhage.
- New AAICH treatments with prothrombotic potential require rigorous evaluation in randomized controlled trials.
Background:
The characteristics of patients with anticoagulant-associated intracerebral hemorrhage (AAICH) have not been well characterized in a population-based setting.
Methods:
We attempted to ascertain all patients with ICH in Greater Cincinnati from May 1998 to July 2001 and August 2002 to April 2003 via retrospective review of ICD-9 codes 430-438.9 at all area hospitals and prospective surveillance at tertiary centers. Cases of ICH without coagulopathy and AAICH were compared with multivariate logistic modeling and survival analysis.
Results:
AAICH occurred in 190 of 1041 ICH cases (18%). In multivariate analysis, predictors of AAICH were cerebellar location of hemorrhage (p = 0.01) and a history of coronary artery disease (p < 0.001), ischemic stroke (p < 0.001), atrial fibrillation (p < 0.001) and DVT or PE (p < 0.001). Relative to other ICH locations, only cerebellar ICH showed an excess risk of anticoagulant-associated hemorrhage (OR 2.2, 95% CI 1.2 to 4.0). In multivariate modeling the only predictor of cerebellar location of ICH was anticoagulation (p < 0.001). Patients with AAICH were more likely to die than other ICH patients. The difference in morality occurred by day one (mortality 33.2% vs 16.3%, p < 0.001) and remained stable through one year (mortality 66.3% vs 50.3%, p < 0.001).
Conclusions:
AAICH preferentially affects the cerebellum. Despite its association with amyloid angiopathy, lobar ICH was no more likely to be anticoagulant-associated than deep cerebral ICH. The excess mortality among AAICH patients accrues within one day of hemorrhage. Patients with AAICH have a high burden of vascular risk factors. New treatments for AAICH with prothrombotic potential should be evaluated in randomized controlled trials before routine use.
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