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Abstract 80: Trends in Anticoagulant-Associated Intracerebral Hemorrhage and Cardioembolic Ischemic Stroke


 Background:
 The incidence of anticoagulant-associated intracerebral hemorrhage (AAICH) quintupled in our population in the 1990s, while rates of ischemic stroke attributed to atrial fibrillation remained stable. We now extend our study to examine incidence trends for these stroke subtypes through 2010.
 
 
 Methods:
 We identified all patients presenting to an emergency department or hospitalized with first-ever ICH in the Greater Cincinnati/Northern Kentucky region during 1988, from 7/93-6/94, and during 1999, 2005, and 2010. AAICH was defined as ICH in patients receiving warfarin, heparin, or a direct thrombin inhibitor. Patients from the same region presenting to an emergency department or hospitalized with first-ever ischemic stroke were identified during 1993/4, 1999, 2005, and 2010. Incidence rates were calculated and adjusted to the 2000 United States population. Estimates of warfarin distribution (in the form of “counting units”) in the United States were obtained for the years 1988 through 2010 from the MIDAS database of IMS Health, Inc.
 Results:
 AAICH occurred in 9 of 184 ICH cases (5%) in 1988, 23 of 267 cases (9%) in 1993/4, 54 of 311 cases (17%) in 1999, 63 of 320 cases (20%) in 2005, and 53 of 303 cases (17%) in 2010 (p < .001 for trend). The annual incidence of AAICH increased in the 1990s but remained stable from 1999 to 2010 (p = .29, see table). Incidence rates of ischemic stroke due to atrial fibrillation were stable in the 1990s but increased from 1999 to 2010 (p = .03, see table). Warfarin distribution in the United States quadrupled on a per-capita basis between 1988 and 1999 and grew at a slower rate thereafter.
 Conclusions:
 The incidence of AAICH quintupled during the 1990s but stabilized in the 2000s. The incidence of ischemic stroke due to atrial fibrillation has not declined in our population in the last two decades, despite increasing warfarin use.
 
 
 
