Warfarin-associated Intracerebral Hemorrhage is Increasing in Prevalence in the United States

Department of Neurology, Northwestern University-Feinberg School of Medicine, Chicago, Illinois. Electronic address: .
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association (Impact Factor: 1.67). 12/2012; 22(7). DOI: 10.1016/j.jstrokecerebrovasdis.2012.11.015
Source: PubMed


Warfarin-associated intracerebral hemorrhage (WAICH) is expected to increase in prevalence as the population ages. We sought to evaluate national trends, characteristics, and in-hospital outcomes among intracerebral hemorrhage (ICH) patients taking warfarin at baseline.

We reviewed the Nationwide Inpatient Sample to identify all admissions with primary diagnosis of ICH by International Classification of Diseases, Ninth Revision code (431) from 2005 to 2008. We identified premorbid warfarin use by the V code (V58.93) and calculated the proportion of WAICH among all ICH patients in each year. We employed univariate statistics and generalized estimating equation regression models to assess whether warfarin use independently increased the risk of in-hospital mortality after adjusting for relevant covariates. P value less than .05 was considered significant.

There were 52,993 patients (mean age 68.8 years; 49.7% male) coded for ICH between 2005 and 2008. The proportion with WAICH increased each year (2005, 5.8%; 2006, 6.5%; 2007, 6.9%; 2008, 7.3%; P < .001). While in-hospital mortality declined each year for non-WAICH (29.0%-25.4%, P < .001), it remained unchanged for WAICH (42.1%-40.0%, P = .346). In multivariable analysis, warfarin use (adjusted odds ratio 1.35; 95% confidence interval 1.24-1.47) remained an independent predictor of in-hospital mortality.

WAICH is increasing in prevalence in the United States and is associated with a 35% higher mortality than non-WAICH. While mortality has declined over time for non-WAICH, mortality after WAICH is unchanged. Specific strategies to decrease the mortality of WAICH such as rapid reversal of anticoagulation are warranted.

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    • "The rate of severe bleeding complications is above 3.8% per person-year and the associated mortality rate ranges between 10 to 60%, especially in case of intracranial hemorrhage (ICH), in the first week following the onset of the hemorrhage [1-4]. In case of severe hemorrhage, the two main predictors of poor prognosis are over anticoagulation, that is, an international normalized ratio (INR) above the therapeutic range, and late VKA reversal (over eight hours after presentation) [5,6]. "
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