Abstract 177: Oral Anticoagulation Related Intracerebral Hemorrhage Is Becoming More Common and Less Fatal. A Nationwide Study From Finland
Background and Purpose: Intracerebral hemorrhage (ICH) is a highly lethal stroke subtype, especially when associated with oral anticoagulation (OAC). We sought to explore the frequency and case-fatality of OAC-ICH in a nationwide consecutive database of all hospitalized incident cases in Finland, the country with the most rapidly aging population in Europe.
Methods: The data from 1999 to 2010 were extracted from the PERFECT Stroke registry, a national database of all incident stroke patients hospitalized in Finland. OAC-ICH was defined as a first-in-a-lifetime ICH admission in a patient using warfarin, the only OAC available during the study period in Finland. Case-fatality was determined by linking to the national death registry using a unique identifier, which ensured 100% follow-up.
Results: Over the 12 years, there were 17,185 cases of ICH registered out of which 2354 (13.7%) were on OAC at the time of their ICH. The annual number of OAC-ICH patients increased from 178 to 269 (+51%) with no increase in annual non-OAC-ICH (1271 to 1228; -3%). The median age increased from 76 to 79 in the OAC-ICH cases, staying at 71 in the non-OAC-ICH cases, while the national population older than 75 increased from 223,000 to 436,000 (+95%). After age and sex adjustment to the common year 1999, the national incidence of OAC-ICH remained at 3.5 to 3.7 per 100 000 population (non-significant change of +6%; 95% CI -8% to +22%), while non-OAC-ICH decreased from 24.1 to 18.9 per 100,000 (-22%; -17% to -26%). In OAC-ICH, case-fatality at 28 days decreased from 51.2% in 1999-2000 to 43.4% in 2009-2010 (annual trend -0.9%; 95% CI -0.3% to -1.4%; P=0.005). The decrease in 28-day case-fatality was smaller in non-OAC-ICH (30.2% to 25.9%; annual trend -0.3%; 95% CI -0.1% to -0.5%; P=0.002). Sensitivity analyses were done adjusting for age, sex, and comorbidities, with similar Results annual trend -0.9% (P=0.002) and -0.4% (P<0.001) for OAC and non-OAC ICH correspondingly.
Conclusion: As the population ages, the proportion of ICH that is related to oral anticoagulation increases, in our series from 12% to 18% over 12 years. While the age and sex adjusted incidence of ICH in general is decreasing, that is not the case with OAC-ICH. Reassuringly, survival from OAC-ICH is improving.
Author Disclosures: A. Meretoja: None. A. Malmivaara: None. R.O. Roine: None. U. Hakkinen: None. M. Kaste: None.
- © 2014 by American Heart Association, Inc.