Recurrent brain hemorrhage is more frequent than ischemic stroke after intracranial hemorrhage

Objective: To characterize the rates of recurrent intracranial hemorrhage ( ICH), ischemic stroke, and death in survivors of primary ICE. Methods: Syst ematic review of studies reporting recurrent stroke in survivors of primary ICH, identified at index ICH and followed forward. Studies were identified by computerized search of the literature and review of reference lists. Re sults: Ten studies published between 1982 and 2000 reporting 1,880 survivor s of ICH, followed for a total of 6,326 patient-years (mean follow-up, 3.4 patient-years), were included. The aggregate rate of all stroke from five s tudies was 4.3% per patient-year (95% CI, 3.5% to 5.4%). The rate in the th ree population-based studies was higher than in the two hospital-based stud ies, 6.2% versus 4.0% per patient-year (p = 0.04). About three fourths of r ecurrent strokes were ICH. Considering all 10 studies, a total of 147 patie nts had a recurrent ICH, an aggregate rate of 2.3% per patient-year (95% CI , 1.9% to 2.7%). Based on data from four studies, patients with a primary l obar ICH had a higher rate of recurrent ICH than those with a deep, hemisph eric ICH (4.4% versus 2.1% per patient-year; p = 0.002). The aggregate rate s of subsequent ischemic stroke and mortality were 1.1% per patient-year (9 5% CI, 0.8% to 1.7%) and 8.8% per patient-year (95% CI, 5.2% to 11.0%). Con clusions: Recurrent stroke among survivors of primary ICH occurs at a rate of about 4% per patient-year, and most are recurrent ICH. Survivors of ICH have a higher risk of recurrent ICH than of ischemic stroke, and this has i mplications for the use of antithrombotic agents in these patients.