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Traumatic and spontaneous intracranial hemorrhage in atrial fibrillation patients on warfarin

Heidi Lehtola1, Antti Palomäki1, Pirjo Mustonen1

  • 1Department of Medicine (HL, PM), Keski-Suomi Central Hospital, Jyvaskyla; Department of Cardiology (HL), Oulu University Hospital; Heart Center (AP, TK, HS, AY, KEJA) and Department of Acute Internal Medicine (IN), Turku University Hospital; NeuroCenter (PH), Kuopio University Hospital; University of Turku (IN, KEJA); Satakunta Central Hospital (AY), Pori; and Heart Center (JH), Kuopio University Hospital and University of Eastern Finland.

Neurology. Clinical Practice
|August 25, 2018
PubMed

Insights

Traumatic intracranial hemorrhages are common in atrial fibrillation patients on oral anticoagulation. These traumatic bleeds, often subdural, are less fatal than spontaneous ones, which are typically intracerebral.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Intracranial hemorrhage (ICH) is a severe complication for patients with atrial fibrillation (AF) on oral anticoagulation (OAC).
  • ICH can occur spontaneously or due to head trauma.
  • Understanding the characteristics and outcomes of traumatic vs. spontaneous ICH in this population is crucial.

Purpose of the Study:

  • To determine the prevalence, clinical features, and prognosis of traumatic and spontaneous intracranial hemorrhages in AF patients receiving OAC.
  • To compare the characteristics and outcomes of traumatic ICH versus spontaneous ICH in anticoagulated AF patients.

Main Methods:

  • Analysis of data from the multicenter FibStroke registry, including 5,629 patients treated with warfarin between 2003 and 2012.
  • Identification and classification of 592 intracranial hemorrhages into traumatic or spontaneous categories.
  • Comparison of patient demographics, clinical characteristics, laboratory values (INR), and risk scores (CHA2DS2-VASc, HAS-BLED) between the two hemorrhage groups.

Main Results:

  • Forty percent of ICH events in AF patients on OAC were traumatic, predominantly subdural hematomas (SDHs).
  • Spontaneous hemorrhages were more often intracerebral (ICHs).
  • Patients with traumatic ICH were older and had higher rates of heart failure and anemia; however, 30-day mortality was lower (25%) compared to spontaneous ICH (36%).

Conclusions:

  • A significant portion of intracranial hemorrhages in AF patients on OAC are trauma-related.
  • Traumatic hemorrhages, mainly SDHs, have a better prognosis than spontaneous ICHs.
  • Risk stratification scores (CHA2DS2-VASc, HAS-BLED) and admission INR were similar between traumatic and spontaneous ICH groups.
Abstract

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