Prevalence of atrial fibrillation in intracerebral hemorrhage

Background and purpose Oral anticoagulation ( OAC ) is an effective preventive therapy for ischemic stroke in atrial fibrillation ( AF ). The management of anticoagulation in AF patients with previous intracerebral hemorrhage ( ICH ) is challenging. The aim of this study was to determine the prevalence of AF after acute ICH in a consecutive monocenter cohort, and to document the subsequent management with respect to OAC . Methods Consecutive patients with spontaneous ICH were prospectively included within 19 months. Diagnosis of AF was based on medical history, 12‐lead electrocardiogram ( ECG ), 24‐h and continuous ECG monitoring. CHADS 2 scores and patient medication were recorded at admission and after 3 months. Additionally, after 3 months mortality, the management of anticoagulation and a newly detected AF were assessed. Results In total, 206 ICH patients were eligible for data analysis. After 3 months, AF had been diagnosed in 64/206 ICH patients (31.1%). Mortality after 3 months was higher in patients with AF in univariate analysis (45.3% vs. 31.0%). After adjusting for comorbidities and OAC use, AF did not remain an independent predictor for mortality. In total, 35 patients with AF survived 3 months. Of these, CHADS 2 score was 2 (2/3, median, interquartile range ( IQR )) and 27/35 patients had an indication for OAC with respect to the CHADS 2 score, but only 25.7% had been (re‐)started on OAC . No consistent factors for deciding whether to initiate OAC treatment could be identified. Conclusions Atrial fibrillation is a frequent comorbidity in patients suffering an ICH . Our findings underline the prevailing uncertainty regarding the anticoagulation management of AF after ICH .