Major bleeding during anticoagulation after cerebral ischemia - Patterns and risk factors

Objective: To assess independent predictors of hemorrhage in 651 anticoagul ated patients. Background: An excess incidence of major bleeding (7% per ye ar) in patients with nondisabling cerebral ischemia of presumed arterial or igin treated with oral anticoagulation led to early termination of the Stro ke Prevention In Reversible Ischemia Trial (SPIRIT), Methods: The relations hip between known risk factors and hemorrhage was assessed by univariate an d multivariate analyses. We compared the risk factors with those in 225 pat ients anticoagulated because of cerebral ischemia with atrial fibrillation in the European Atrial Fibrillation Trial (EAFT), Results: Leukoaraiosis (h azard ratio [HR] 2.7, 95% confidence interval [CI] 1.4 to 5.3) and age olde r than 65 years (HR 1.9, 95% CI 1.0 to 3.4) were independent predictors of all anticoagulation-related hemorrhages in SPIRIT, The incidence of intracr anial bleeding in SPIRIT was 3.7% per year; this incidence increased by a f actor of 1.37 for each 0.5 unit international normalized ratio (INR), Patie nts with cerebral ischemia of presumed arterial origin had a 19 times (95% CI 2.4 to 150) higher risk of intracranial hemorrhages than those with atri al fibrillation after correcting for baseline differences between SPIRIT an d EAFT patients. Conclusions: In addition to the intensity of anticoagulati on, leukoaraiosis and age older than 65 years are independent risk factors for bleeding in patients anticoagulated because of cerebral ischemia of pre sumed arterial origin. These patients have a higher inherent risk of antico agulation-related intracranial hemorrhages than patients with atrial fibril lation.