Intracerebral Hemorrhage and Warfarin

See related article, pages 2431–2435.Oral anticoagulation (OAC) reduces risk of thromboembolism and is recommended for a wide range of indications, including deep vein thrombosis, pulmonary embolism, and mechanical heart valves, although the most common reason for OAC use is still atrial fibrillation (AF).1 For over 60 years, the vitamin K antagonist class of drugs (eg, warfarin) has been the mainstay of OAC, but with the advent of new OACs such as the oral direct thrombin inhibitors and oral Factor Xa inhibitors, the situation is changing.2Despite proven efficacy in prevention of stroke in AF and thromboembolism (versus both aspirin and placebo),3 warfarin is not always prescribed or taken by patients for a variety of reasons, including its narrow therapeutic range, the need for attendance at anticoagulation clinics, and bleeding risk.4 However, the most feared complication of OAC remains intracerebral hemorrhage (ICH).In this issue of Stroke , Huhtakangas and colleagues5 report the results of their population-based study of incidence of warfarin-associated ICH in Finland. Despite a nearly 4-fold increase in the proportion of warfarin users among the population in the study period (1993 to 2008), the annual incidence and case-fatality of warfarin-associated ICHs decreased. They also observed a decrease in the annual 28-day case-fatality rates …