Abstract

Primary intracerebral hemorrhage (ICH) accounts for 10–15% of all strokes. ICH is the most devastating subtype of stroke with high mortality and morbidity; 35–52% of patients die during the first month after the bleeding. The most important risk factor for onset of ICH is hypertension, especially untreated hypertension, and the well-known predictors for early death after ICH are a low GCS (i.e low level of consciousness) score on admission, the size of the hematoma, and the precence of intraventricular blood. Preceeding use of anticoagulants and advanced age further impair the outcome. Thromboembolic complications after the bleed are common and difficult to prevent.

The present cohort study included all patients (n = 453) with verified primary ICH admitted to the stroke unit of Oulu University Hospital within a period of 11 years (from January 1993 to January 2004). The impacts of previous diseases, including ischemic heart disease, atrial fibrillation on admission, hypertension, and diabetes as well as of high admission blood pressure and plasma glucose levels on outcome were evaluated. The safety and efficacy of prevention of venous thromboembolism with enoxaparin, a low molecular weight heparin (LMWH), was investigated. In a population-based study covering a 3-year period, the risk factors and seasonal distribution of ICH were investigated.

Independent of the severity of bleeding and patients’ age, ischemic heart disease, diabetes, and atrial fibrillation were found to be significant predictors for early death after ICH. High blood pressure on admission predicted early death, whereas elevated admission plasma glucose level was associated with the severity of bleeding but was not an independent predictor for early death. Treatment with enoxaparin (20 mg per day subcutaneously) for prevention of venous thromboembolism was not associated with increased mortality but did not seem to prevent venous thromboembolic complications. The incidence of ICH was higher during the winter among patients with untreated hypertension but not in normotensive and treated hypertensive patients.