Journal of Neurology

, Volume 260, Issue 8, pp 2046–2051 | Cite as

Intracerebral hemorrhage during anticoagulation with vitamin K antagonists: a consecutive observational study

  • S. Horstmann
  • T. Rizos
  • M. Lauseker
  • M. Möhlenbruch
  • E. Jenetzky
  • W. Hacke
  • Th. Steiner
  • R. Veltkamp
Original Communication


Intracerebral hemorrhage (ICH) is the most devastating complication of oral anticoagulation (OAC). As the number of patients on long-term OAC is expected to rise, the proportion of intracerebral hemorrhage related to OAC (OAC-ICH) in relation to spontaneous ICH (spont-ICH) is expected to increase as well. We determined the proportion of OAC-ICH in consecutive stroke patients and explored differences between OAC-ICH and spont-ICH regarding initial volume, hematoma expansion and outcome. Our prospective study consecutively enrolled patients with supra- and infratentorial ICH. The National Institute of Health Stroke Scale Score and the modified Rankin Scale (mRS) score at baseline and after 3 months, medical history and demographic variables were recorded. All admission and follow-up CTs/MRIs were analysed regarding ICH volume using the ABC/2-method. Intraventricular hemorrhage (IVH) was quantified using the Graeb score. Within 19 months, 2,282 patients were admitted to our ER. 206 ICH patients were included. Overall, 24.8 % of all ICH were related to OAC. Compared to patients with spont-ICH, OAC-ICH patients were older (p = 0.001), more frequently had initial extension of ICH into the ventricles (p = 0.05) or isolated primary IVH (p = 0.03) and a higher Graeb score upon admission (p = 0.01). In contrast, initial ICH volume (p = 0.16) and ICH expansion (p = 0.9) in those receiving follow-up imaging (n = 152) did not differ between the two groups. After correction for age, there was a trend towards poorer outcome in OAC-ICH (p = 0.08). One-fourth of all ICH are related to OAC. Initial extension of ICH into the ventricles and primary IVH are more frequent in OAC-ICH. The rate of hematoma expansion in OAC-ICH patients is similar to non-anticoagulated ICH patients.


Intracerebral hemorrhage Oral anticoagulation Outcome Mortality Warfarin 


Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • S. Horstmann
    • 1
  • T. Rizos
    • 1
  • M. Lauseker
    • 1
  • M. Möhlenbruch
    • 2
  • E. Jenetzky
    • 3
  • W. Hacke
    • 1
  • Th. Steiner
    • 4
  • R. Veltkamp
    • 1
  1. 1.Department of NeurologyUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of NeuroradiologyUniversity of HeidelbergHeidelbergGermany
  3. 3.Department for Child and Adolescent PsychiatryJohannes Gutenberg-UniversityMainzGermany
  4. 4.Klinikum Höchst GmbHFrankfurt a. M.Germany

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