Spontaneous intracerebral hemorrhage most often occurs in adults 80 years or older

Key takeaways:

• Only a small portion of those with spontaneous intracerebral hemorrhage were eligible for surgery.
• Use of anticoagulant medications were associated with unfavorable outcomes following stroke.

The highest incidence of spontaneous intracerebral hemorrhage in Southwestern Finland, standardized to European average, occurred in men and women aged at least 80 years, according to research published in Brain and Spine.

“The incidence of spontaneous intracerebral hemorrhage in Europe varies but is generally reported to be around 25 to 30 cases per 100,000 person-years,” Sami Lehto, from the department of neurosurgery, Turku University Hospital, and colleagues wrote. “The incidence of [spontaneous intracerebral hemorrhage (sICH)] that could benefit from surgical treatment is not widely reported due to the lack of definitive evidence and selection criteria supporting the benefits of surgical intervention.”

Lehto and colleagues sought to determine the incidence of sICH in Southwest Finland compared with the rest of Europe and to identify the proportion of large sICH patients eligible for surgery based on previously published clinical trial criteria. The researchers additionally examined outcome-related factors such as efficacy of anticoagulant and antithrombotic medications.

Their retrospective study included patient records from Turku University Hospital between 2018 and 2019 on 596 cases of intracerebral hemorrhage, of which 286 were supratentorial sICHs (mean age, 74.45 years; 53% women).

The volume of intracerebral hemorrhage was measured by head CT taken at initial hospital admission.

According to the results, the total estimated incidence of sICH was 29.9 per 100,000 persons per year.

Divided by age and sex, the standardized incidence rates were as follows: for men, 12 per 100,000 in those aged 20 to 39 years; 57 per 10,000 in those aged 40 to 59 years; 31 per 100,000 in those aged 60 to 79 years; and 110 per 100,000 in those aged 80 years and older; for women, 16 per 100,000 in those aged 20 to 39 years; 42 per 100,000 in those aged 40 to 59 years; 35 per 100,000 in those aged 60 to 79 years; and 142 per 100,000 for those aged 80 years and older.

Data further show that the incidence of sICH aligned with surgical criteria was 2.7 per 100,000 persons per year, with 26 individuals out of 286 eligible for surgery who had unfavorable outcomes. Good functional outcomes (Modified Rankin Scale score of 0 to 3 at 3 months) were observed in fewer individuals eligible for surgery (4 of 22, 15.4%) compared with those who were ineligible (114 of 228, 49.1%). Factors associated with favorable outcomes, according to data, were younger age, fewer do-not-resuscitate orders and smaller sICH volume.

A multivariate analysis on the efficacy of anticoagulant medications yielded a significant decrease in favorable outcomes with warfarin (OR = 0.42) and direct-acting anticoagulants (OR = 0.38), with no significant effect found with respect to antithrombotics.

“Only a small proportion of sICH met the criteria for surgical intervention,” Lehto and colleagues wrote. “Given the substantial morbidity associated with sICH, further clinical trials and studies are essential to refine treatment strategies and improve quality of life.”