Trends in Incidence of Intracerebral Hemorrhage and Association With Antithrombotic Drug Use in Denmark, 2005-2018

Abstract

Key Points Question Is use of antithrombotics associated with intracerebral hemorrhage (ICH), and is increased use of these drugs in recent years associated with increasing incidence of ICH in Denmark? Findings In this case-control study of 16 765 ICH cases, ICH was statistically significantly associated with antithrombotic drug use, including vitamin K antagonists, direct oral anticoagulants, clopidogrel, and low-dose aspirin. Whereas antithrombotic drug use (mainly direct oral anticoagulants) increased during 2005 to 2018, the incidence of ICH did not. Meaning In Denmark, increased use of antithrombotics was not associated with an increase in the incidence of ICH.

Association of Long-term Statin Use With the Risk of Intracerebral Hemorrhage

“…It, however, is unlikely that SES had an important effect on our results because previous analyses found that the addition of education and income to a model similar to the one used in this study had very little effect on ICH risk estimates. 19 Third, our data were from people who were primarily of European ancestry and may not be generalizable to other populations. As in all observational studies, residual confounding by unmeasured variables remains possible.…”

“…We identified patients with ICH as previously described. 19 In brief, cases were all patients with a first-ever diagnosis of ICH in the Danish Stroke Registry 20 (DSR) during the study period. The index date was the date of hospital admission for ICH.…”

Recommendations from the ICM-VTE: General

“…This risk has been extensively studied in the population of patients with atrial fibrillation, where a reduction in the incidence of intracranial bleeding was observed with the use of the direct-oral anticoagulants (DOAC) as compared to VKA 2050 . A recent study from Denmark reported a strong association between the use of antithrombotic drugs and the risk of intracranial bleeding in the general population 2051 . This association was weakest for the use of low dose aspirin (ASA) and clopidogrel and strongest with the use of VKA.…”

Intracerebral Hemorrhage and Exposure to Antithrombotic Drugs

“…In this issue of JAMA Network Open , the findings of Hald et al 2 are reassuring in this regard because they found that despite increased use of anticoagulants, largely driven by DOAC use, ICH prevalence has not increased in a Danish population. Hald et al 2 investigated associations between exposure to antithrombotic drugs and subsequent odds of ICH among Danish residents. Using a case-control study design, they identified cases as individuals with an incident ICH diagnosis obtained from a dedicated stroke registry.…”

“…The provided evidence from Hald et al 2 on the strength of the association between antithrombotic use and ICH carries little clinical value in terms of how best to approach patients who present with an ICH. We already know, for example, that patients with ICH and atrial fibrillation are at high risk for subsequent ischemic stroke and death, but the immediate concern is that of recurrent bleeding.…”