Influence of antithrombotics on the etiology of intracerebral hemorrhage
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Published on: July 3, 2014
Sherri A Braksick1, James P Klaas1, Robert D Brown1
1Department of Neurology, Mayo Clinic, Rochester, Minnesota.
Insights
Antithrombotic use does not influence the cause of primary intracerebral hemorrhage (ICH). Hypertension remains the leading cause of ICH across all age groups, including older adults and those with cerebral amyloid angiopathy (CAA).
Area of Science:
- Neurology
- Vascular Neurology
- Neurocritical Care
Background:
- Intracerebral hemorrhage (ICH) is a critical neurological event.
- Understanding the etiological factors of primary ICH is crucial for prevention and treatment.
- The role of antithrombotic medications in ICH etiology requires further investigation.
Purpose of the Study:
- To investigate the influence of antithrombotic medication use on the primary causes of intracerebral hemorrhage (ICH).
- To analyze the relationship between patient demographics, antithrombotic use, and ICH etiology.
Main Methods:
- A retrospective review of 292 patients admitted with primary ICH between 2009 and 2012.
- Data collected included patient age, hypertension history, and antithrombotic medication use.
- Hemorrhage location and microhemorrhages were assessed via imaging, with etiologies classified using a standardized algorithm.
Main Results:
- Hypertension was the most common etiology (50.6%), followed by indeterminate causes (29.5%) and cerebral amyloid angiopathy (CAA) (19.9%).
- The majority of patients (61.3%) were using antithrombotic medications.
- No significant difference in antithrombotic or anticoagulant use was observed between patients with CAA-associated ICH and other causes of ICH.
Conclusions:
- Hypertension is the predominant etiology of primary ICH, irrespective of patient age.
- The increased incidence of ICH in older patients or those with CAA-ICH is not attributable to a higher frequency of anticoagulant use.
- Findings suggest antithrombotic use does not alter the primary drivers of intracerebral hemorrhage.
Background:
To determine the influence of antithrombotic use on the etiology of primary intracerebral hemorrhage (ICH).
Methods:
We conducted a retrospective review of consecutive patients admitted with primary ICH from 2009 to 2012. Data recorded included age, history of hypertension, and use of antithrombotic medications. Imaging was reviewed to determine hemorrhage location and the presence and the location of any microhemorrhages. Etiologies were classified using a predetermined algorithm, which was based on existing literature.
Results:
In total, 292 patients were included. Median age was 74 years (range, 18-101), and 52% were male (n = 151). Hemorrhage etiology was hypertension in 50.6% (n = 148), indeterminate in 29.5% (n = 86), and cerebral amyloid angiopathy (CAA) in 19.9% (n = 58). Most patients were on antithrombotics (61.3%, n = 179). Nearly half of the patients (49%) were 75 years of age or older, and the most common etiology in this group was hypertension (n = 77, 53%). There was a nonsignificant trend toward older age and CAA-ICH (median age, 77 years; interquartile range [IQR], 70-82 years) compared with other causes (median age, 74 years; IQR, 61-82 years; P = .07). There was no difference between CAA-ICH and other-cause ICH with respect to proportion of patients on antithrombotics in general (67% versus 60%; P = .367) or anticoagulants in particular (24% versus 25%; P = 1.000).
Conclusions:
The most common ICH etiology in this study was hypertension, regardless of age. Our findings do not suggest that the higher occurrence of ICH in older patients or in patients with CAA-associated ICH is because of a higher frequency of anticoagulant use.
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