Related Experiment Video
Updated: May 9, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Prevalence of atrial fibrillation in intracerebral hemorrhage
S Horstmann1, T Rizos, E Jenetzky
1Department of Neurology, University of Heidelberg, Heidelberg, Germany.
Insights
Atrial fibrillation (AF) is common after intracerebral hemorrhage (ICH). Few survivors restart oral anticoagulation (OAC), highlighting uncertainty in managing AF patients post-ICH.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Atrial fibrillation (AF) increases ischemic stroke risk.
- Oral anticoagulation (OAC) is standard for AF stroke prevention.
- Managing OAC in AF patients with prior intracerebral hemorrhage (ICH) is complex.
Purpose of the Study:
- Determine AF prevalence post-acute ICH.
- Document OAC management in these patients.
- Assess factors influencing OAC decisions.
Main Methods:
- Prospective cohort study of spontaneous ICH patients.
- AF diagnosis via history, ECG, and Holter monitoring.
- Assessment of CHADS₂ scores, medication, and outcomes at 3 months.
Main Results:
- AF diagnosed in 31.1% of ICH patients within 3 months.
- 3-month mortality higher in AF patients (univariate analysis).
- Only 25.7% of eligible AF survivors restarted OAC; no clear decision factors identified.
Conclusions:
- AF is a frequent comorbidity following ICH.
- Significant uncertainty exists in OAC management for AF patients post-ICH.
- Clinical practice regarding OAC initiation needs further investigation.
Background And Purpose:
Oral anticoagulation (OAC) is an effective preventive therapy for ischemic stroke in atrial fibrillation (AF). The management of anticoagulation in AF patients with previous intracerebral hemorrhage (ICH) is challenging. The aim of this study was to determine the prevalence of AF after acute ICH in a consecutive monocenter cohort, and to document the subsequent management with respect to OAC.
Methods:
Consecutive patients with spontaneous ICH were prospectively included within 19 months. Diagnosis of AF was based on medical history, 12-lead electrocardiogram (ECG), 24-h and continuous ECG monitoring. CHADS₂ scores and patient medication were recorded at admission and after 3 months. Additionally, after 3 months mortality, the management of anticoagulation and a newly detected AF were assessed.
Results:
In total, 206 ICH patients were eligible for data analysis. After 3 months, AF had been diagnosed in 64/206 ICH patients (31.1%). Mortality after 3 months was higher in patients with AF in univariate analysis (45.3% vs. 31.0%). After adjusting for comorbidities and OAC use, AF did not remain an independent predictor for mortality. In total, 35 patients with AF survived 3 months. Of these, CHADS₂ score was 2 (2/3, median, interquartile range (IQR)) and 27/35 patients had an indication for OAC with respect to the CHADS₂ score, but only 25.7% had been (re-)started on OAC. No consistent factors for deciding whether to initiate OAC treatment could be identified.
Conclusions:
Atrial fibrillation is a frequent comorbidity in patients suffering an ICH. Our findings underline the prevailing uncertainty regarding the anticoagulation management of AF after ICH.
Related Concept Videos
01:17Hemorrhagic Stroke l: Introduction
01:29Hemorrhagic Stroke ll: Pathophysiology
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:29Stroke: Introduction and Types