Hematoma Growth in Oral Anticoagulant Related Intracerebral Hemorrhage

Background and Purpose-Limited data suggest that intracerebral hemorrhage related to oral anticoagulant therapy (OAT ICH) is associated with more hemorrhage expansion and a worse prognosis than spontaneous ICH (SICH). Methods-We examined patients enrolled in the placebo arm of the CHANT study, a prospective randomized trial of a putative neuroprotectant in patients with ICH. All patients had neuroimaging within 6 hours of symptom onset and at 72 hours. Initial ICH volume and hemorrhage expansion were determined by a central reader. Multivariable logistic regression was used to determine factors associated with ICH expansion and mortality at 90 days. Results-Of 303 patients included, 21 (6.9%) had OAT ICH. Baseline median ICH volume was greater in patients with OAT ICH compared to SICH (30.6 versus 14.4 mL, P = 0.03). Hemorrhage expansion (defined as >33% increase in ICH volume) occurred in 56% of patients with OAT ICH compared to 26% of SICH (P = 0.006). Mortality was substantially higher in OAT ICH (62% versus 17%, P < 0.001). In multivariable analysis, time to neuroimaging and oral anticoagulant use were independently associated with hemorrhage expansion, and age, gender, and oral anticoagulant use were independently associated with mortality. Conclusions-These findings confirm that OAT ICH is associated with more hemorrhage expansion and greater mortality than SICH. (Stroke. 2008; 39: 2993-2996.)