A recently published review of casesof intracerebral hemorrhage (ICH)showed rates of anticoagulant-associatedICH (AAICH) that quintupled from1988 to 1999. Researchers in the Cincinnati,Ohio, area identified all patientswho experienced a first episode of ICHduring 3 time periods (1988, 1993 to1994, and 1999). Patients from thesame region with admissions for cardioembolicstroke were also identifiedin order to compare the rates of these2 types of events.
AAICH increased from 5% of ICHcases in 1988 to 17% in 1999. The rateof AAICH per 100,000 persons was 0.8in 1988 and 4.4 in 1999. In patientsolder than 80 years of age, the rateincreased from 2.5/100,000 persons to45.9/100,000 persons. The incidence ofcardioembolic stroke did not changesignificantly during the study period.The authors determined that warfarinuse quadrupled from 1988 to 1999,explaining most of the increase in therates of AAICH. The results of this studyare positive in that more patients arereceiving treatment according to guidelines.They also reinforce the need forcareful monitoring of anticoagulation.
Dr. Garrett is a clinical pharmacistpractitioner at Cornerstone HealthCare in High Point, NC.