Impact of coagulation disorders on intracranial hemorrhage outcomes: a case-controlled study

Intracranial hemorrhage (ICH) is a severe condition associated with high morbidity and mortality. Coagulation disorders, such as thrombophilia, thrombocytopenia, hemophilia, and vitamin K deficiency, significantly influence the pathophysiology of bleeding, and therefore the outcomes of ICH patients. This study aims to examine the effects of these disorders on outcomes related to ICH. This study retrospectively examined the impact of these coagulation disorders on ICH outcomes using the Nationwide Inpatient Sample (NIS) database from 2011 to 2020. A total of 260,049 hospitalizations for ICH were included, and patients were grouped based on the presence of specific coagulation disorders. The outcomes assessed were in-hospital mortality and length of stay (LOS), with case-controlled matching applied to account for confounding variables such as age, sex, race, and comorbidities. Overall, the mortality rate across all 269,044 patients was 21.9%. ICH patients with vitamin K deficiency had the highest mortality rate (40.5%), followed by thrombocytopenia (28.2%) and primary thrombophilia (30.8%) (p < 0.001). Hemophilia and von Willebrand disease were associated with mortality rates of 21.6% and 32.1%, respectively. Additionally, vitamin K deficiency and hemophilia were linked to the longest LOS among the conditions studied (17.6 ± 23.9 days and 14.1 ± 18.1 days respectively) p < 0.001). Case-controlled matching confirmed significant differences in mortality and LOS based on the type of coagulation disorder after controlling for confounding variables. This study demonstrates the significant role of coagulation disorders in determining ICH outcomes. Vitamin K deficiency and thrombocytopenia were associated with particularly severe outcomes, including increased mortality and extended hospital stays. Early identification and targeted interventions for these coagulation disorders are crucial for improving ICH management and patient prognosis. Further research is needed to develop comprehensive guidelines for managing ICH patients with coagulation disorders.