Secular Trends in the Background of Intracerebral Hemorrhage from 2010 to 2015

Objective:Direct oral anticoagulants (DOACs) were recently introduced for the clinical use in stroke prevention, and they are reported to show a lower risk of intracerebral hemorrhage (ICH) compared to warfarin. We were interested to know whether there is any change in clinical backgrounds of ICH patients to date. Methods: From 2010 to 2015, ICH patients admitted to our hospital were consecutively screened (n = 658). Hematoma size was assessed by brain computed tomography images on admission. Outcome was measured by the modified Rankin Scale, and favorable outcome was defined as modified Rankin Scale 0-2. Biennial trends were compared in 3 periods, P1: 2010-2011, P2: 2012-2013, and P3: 2014-2015. Results:The percentage of ICH patients taking antithrombotics had been slightly decreasing (P = .245: [P1] 33.0%, [P2] 27.4%, and [P3] 26.2%). The frequency of patients taking antiplatelets had significantly decreased (P = .001: [P1] 50.7%, [P2] 44.3%, and [P3] 22.8%), and those taking DOACs had significantly increased (P = .001: [P1] 1.4%, [P2] 4.9%, and [P3] 19.3%). Frequency of favorable outcomes in patients taking antithrombotics was slightly increased in P3 compared to P1 and P2 (23.3%, 21.1%, and 21.3%, respectively). There was no significant difference in hematoma size between patients taking warfarin and DOACs. Conclusions: Number of ICH patients taking antithrombotics has been slightly decreasing and the percentage taking DOACs among ICH has been increasing for 6 years.