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A recently published review of cases of intracerebral hemorrhage (ICH) showed rates of anticoagulant-associated ICH (AAICH) that quintupled from 1988 to 1999. Researchers in the Cincinnati, Ohio, area identified all patients who experienced a first episode of ICH during 3 time periods (1988, 1993 to 1994, and 1999). Patients from the same region with admissions for cardioembolic stroke were also identified in order to compare the rates of these 2 types of events.
AAICH increased from 5% of ICH cases in 1988 to 17% in 1999. The rate of AAICH per 100,000 persons was 0.8 in 1988 and 4.4 in 1999. In patients older than 80 years of age, the rate increased from 2.5/100,000 persons to 45.9/100,000 persons. The incidence of cardioembolic stroke did not change significantly during the study period. The authors determined that warfarin use quadrupled from 1988 to 1999, explaining most of the increase in the rates of AAICH. The results of this study are positive in that more patients are receiving treatment according to guidelines. They also reinforce the need for careful monitoring of anticoagulation.
Dr. Garrett is a clinical pharmacist practitioner at Cornerstone Health Care in High Point, NC.