gms | German Medical Science

Objective: In previous studies, pretreatment with oral anticoagulants was identified as a predictor of in-hospital mortality after intracerebral hemorrhage (ICH). The present study was conducted to observe the relation between pretreatment with oral anticoagulants and antiplatelet agents in different ICH subgroups.

Methods: The current analysis was based on a large, country-wide stroke registry in Germany. Between the year 2007 and 2009, all cases with the final diagnosis of intracerebral hemorrhage (ICD-10 I61) were selected. Only patients with deep hematomas (I61.0), lobar (I61.1), cerebellar (I61.3) and brainstem hemorrhage (I61.4) were included. All analyzed parameters including International Classification of Diseases (ICD), pre-hospital status (modified Rankin Scale, mRS), age and pretreatment with antiplatelet agents or oral anticoagulants were collected prospectively. Endpoints were in-hospital mortality rate and unfavorable outcome at hospital discharge (mRS > 2).

Results: A total of 2754 patients were included in our analysis. A pretreatment with antiplatelet agents was found in 28.2%. Oral anticoagulants were taken by 16.5% at the time of the hemorrhage. Hematomas were located deep in the cerebrum, in a lobe, in the cerebellum and in the brainstem in 46.9%, 20.2%, 22.4% and 10.5% of the cases, respectively. Overall in-hospital mortality was 19.5%. An unfavorable outcome at hospital discharge was recorded in 75.8%. A pretreatment with antiplatelet agents was found to be a predictor for in-hospital mortality for deep intracerebral hematomas (OR: 1.4; 95% CI: 1 - 1.9; P = 0.034). After adjustment for age and pre-hospital status, a pretreatment with antiplatelet agents was no longer an independent predictor (OR: 1.0; 95% CI: 0.7 - 1.4; P = 0.914). A therapy with oral anticoagulants was identified as independent predictor of in-hospital mortality for deep intracerebral hematomas (OR: 1.7; 95 % CI 1.2 - 2.4; P = 0.003). After adjustment for age and pre-hospital status, pretreatment with oral anticoagulants remains an independent predictor (OR: 1.6; 95% CI: 1.1 - 2.4; P = 0.015). No statistical significant association was seen between pretreatment with antiplatelet agents or oral anticoagulants for in-hospital mortality and outcome for lobar, cerebellar, and brainstem hematomas after adjustment for age and pre-hospital status.

Conclusions: Pretreatment with oral anticoagulants is an independent predictor of in-hospital mortality only for deep intracerebral hematomas.