Effect of Increased Warfarin Use on Warfarin-Related Cerebral Hemorrhage: A Longitudinal Population-Based Study

Warfarin use has rapidly increased with the aging of the population. We investigated the temporal trends in the incidence and outcome of warfarin-related intracerebral hemorrhages (ICHs) in a defined population. We identified all subjects with first-ever primary ICH during 1993 to 2008 among the pop...

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Bibliographic Details
Published in:Stroke (1970) 2011-09, Vol.42 (9), p.2431-2435
Main Authors: HUHTAKANGAS, Juha, TETRI, Sami, JUVELA, Seppo, SALOHEIMO, Pertti, BODE, Michaela K, HILLBOM, Matti
Format: Article
Language:English
Subjects:
Age Factors
Aged
Aged, 80 and over
Anticoagulants - administration & dosage
Anticoagulants - agonists
Biological and medical sciences
Cerebral Hemorrhage - chemically induced
Cerebral Hemorrhage - mortality
Female
Finland - epidemiology
Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy
Humans
Incidence
International Normalized Ratio - adverse effects
Male
Medical sciences
Middle Aged
Nervous system (semeiology, syndromes)
Neurology
Registries
Retrospective Studies
Vascular diseases and vascular malformations of the nervous system
Warfarin - administration & dosage
Warfarin - adverse effects
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Summary:Warfarin use has rapidly increased with the aging of the population. We investigated the temporal trends in the incidence and outcome of warfarin-related intracerebral hemorrhages (ICHs) in a defined population. We identified all subjects with first-ever primary ICH during 1993 to 2008 among the population of Northern Ostrobothnia, Finland. The number of warfarin users was obtained from the national register of prescribed medicines kept by the Social Insurance Institution of Finland. We calculated the annual incidence of warfarin-related ICHs, 28-day case fatality, and deaths from the primary bleed. The proportion of warfarin users among the population increased 3.6-fold from 0.68% in 1993 to 2.28% in 2008. Of a total of 982 patients with ICH, 182 (18.5%) had warfarin-related ICH. One-year survival rate after onset of stroke was 35.2% among warfarin users and 67.9% among nonusers. The annual incidence (P=0.062) and 28-day case fatality of warfarin-related ICHs (P=0.002) decreased during the observation period. Warfarin users were older (mean difference 6.6; 95% CI, 5.0 to 8.1; P
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.111.615260