Intracerebral Hemorrhage Incidence, Mortality, and Association With Oral Anticoagulation Use

Abstract

Background and Purpose: Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke associated with significant morbidity and mortality. Recent epidemiological data on incidence, mortality, and association with oral anticoagulation are needed. Methods: Retrospective cohort study of adult patients (≥18 years) with ICH in the entire population of Ontario, Canada (April 1, 2009–March 30, 2019). We captured outcome data using linked health administrative databases. The primary outcome was mortality during hospitalization, as well as at 1 year following ICH. Results: We included 20 738 patients with ICH. Mean (SD) age was 71.3 (15.1) years, and 52.6% of patients were male. Overall incidence of ICH throughout the study period was 19.1/100 000 person-years and did not markedly change over the study period. In-hospital and 1-year mortality were high (32.4% and 45.4%, respectively). Mortality at 2 years was 49.5%. Only 14.5% of patients were discharged home independently. Over the study period, both in-hospital and 1-year mortality reduced by 10.4% (37.5% to 27.1%, P <0.001) and 7.6% (50.0% to 42.4%, P <0.001), respectively. Use of oral anticoagulation was associated with both in-hospital mortality (adjusted odds ratio 1.37 [95% CI, 1.26–1.49]) and 1-year mortality (hazard ratio, 1.18 [95% CI, 1.12–1.25]) following ICH. Conclusions: Both short- and long-term mortality have decreased in the past decade. Most survivors from ICH are likely to be discharged to long-term care. Oral anticoagulation is associated with both short- and long-term mortality following ICH. These findings highlight the devastating nature of ICH, but also identify significant improvement in outcomes over time.

Decrease in incidence of oral anticoagulant-related intracerebral hemorrhage over the past decade in the Netherlands

“…Some studies show similar results, 11,27 though most studies report a stable or even increased incidence rate in the older population. [8][9][10]14,16 A possible explanation for a decreased ICH incidence in our study is the further improvement of cardiovascular risk management, in particular antihypertensive management, and less smoking. Favorably, ICHs were smaller and had lower in-hospital mortality in the 2017-2019 cohort compared to the 2007-2009 cohort.…”

“…In other studies, ICH incidence rates range from 10.0 to 46.0 per 100,000 person-years. 6,[8][9][10][11][12]14,16,[27][28][29] However, we determined the adult incidence rate, while some studies report life-time incidence, which leads to lower incidence rates; yet other studies report incidence in an elderly population, which will result in higher incidence rates. Furthermore, the region South-Limburg is known for its lower socioeconomic and health status compared to other regions in the Netherlands, which may result in a higher incidence.…”

“…1 However, the two largest studies to date reporting on ICH incidence outside of the Netherlands found stable ICH incidence rates. 8,9 Several other studies on ICH incidence have been performed, and while some recent studies show a decrease in ICH incidence, others show a stable or even increased ICH incidence rate. 6,7,[10][11][12][13][14][15][16][17] The difference in investigated time-periods, patient selection, and study size, with several studies encompassing single institutional cohorts, could explain these diverse findings.…”

Dysregulation of microRNA and Intracerebral Hemorrhage: Roles in Neuroinflammation

“…Intracerebral hemorrhage (ICH) is one of the most devastating subtypes of stroke, accounting for 10–15% of all stroke cases [ 1 ]. The mortality rate of ICH is 45.4% within one year of initial ictus [ 2 ] and around 74% of ICH survivors remain functionally dependent at one year after the onset of symptoms [ 3 ]. Moreover, the incidence of ICH is expected to increase due to population aging and the spreading use of anticoagulants [ 4 ].…”

Association Between Intraventricular Alteplase Use and Parenchymal Hematoma Volume in Patients With Spontaneous Intracerebral Hemorrhage and Intraventricular Hemorrhage

“…About one-third of patients with spontaneous intracerebral hemorrhage (ICH) die within 1 month of the event, and almost half of patients die during the first year after the index hemorrhage. 1 Despite comprising only 10% to 15% of all stroke subtypes, ICH is responsible for more than two-thirds of overall stroke mortality. 2 Among the factors associated with poor ICH outcomes, the volume of intracranial blood has been identified as one of the most important; other variables include the initial parenchymal ICH volume at the time of ICH diagnosis, subsequent hematoma expansion, and intraventricular hemorrhage (IVH).…”