Introduction: Atrial fibrillation (AFib) patients who have recently experienced intracerebral hemorrhage (ICH) may otherwise have an indication for preventive anticoagulation. The use of anticoagulation in these patients, despite strong evidence of reduction of embolic risk, is controversial and lacks high quality supportive evidence.
Methods: Using data from the National Inpatient Sample from 2010-2012, we estimated the proportion of ICH patients that survive their hospitalization, have AFib, and also an indication for anticoagulation. ICD-9 codes were used to identify ICH patients and relevant co-morbidities. Descriptive statistics and multivariate logistic regression were used.
Results: 39,395 patients had a primary ICD-9 diagnosis of ICH. The mean age was 69 years (SD 15), 49% were women, 18.5% had AFib and 25% died in hospital. Of AFib ICH patients that survived hospitalization (13% of all ICHs), 73% had a CHADS2 score >= 2. In multivariate analysis AFib ICH patients were significantly older, more likely male, Caucasian, had worse outcomes and higher prevalence of all CHADS2 risk factors compared to non-AFib ICHs (all p <= 0.001). AFib ICH patients discharged home with CHADS2 >= 2 comprised 2.2% of all ICH patients, and an additional 7.3% were discharged to rehabilitation or skilled nursing facilities.
Conclusions: AFib ICH patients with appropriate indications for long term preventive anticoagulation represent up to 9.5% of all ICH patients. More research is needed to accurately estimate the rates of subsequent ischemic and hemorrhagic events, stratified by antithrombotic medication use. Such rates can then be used to estimate sample size for a randomized trial comparing the effectiveness of antiplatelet and anticoagulant medications.