Incidence of Ischemic and Thrombotic Events Following Nontraumatic Intracerebral and Subarachnoid Hemorrhages

Thromboischemic events contribute substantially to morbidity and mortality of intracerebral hemorrhage and subarachnoid hemorrhage. Therefore, we aimed to evaluate the incidence of neurologic and systemic thromboischemic events in patients with acute non-traumatic intracerebral hemorrhage and subarachnoid hemorrhage during the first 6 months after hemorrhage.

In this randomized-cohort study, we enrolled 203 patients with acute non-traumatic intracerebral hemorrhage or subarachnoid hemorrhage admitted in the neurology ward of Zanjan Vali-e-Asr Hospital between January 2016 and September 2016. We recorded the risk factors (hypertension, diabetes mellitus, atrial fibrillation, Smoking), initial neurological indices (Glasgow coma scale, ICH score, Hunt and Hess grading), and bleeding size in these patients. Patients were then evaluated 1 week, 1 month, 3 months, and 6 months after intracerebral hemorrhage and subarachnoid hemorrhage for the incidence of deep vein thrombosis, pulmonary embolism, ischemic heart disease, and ischemic stroke.

165 patients had intracerebral hemorrhage and 38 patients had subarachnoid hemorrhage. The cumulative incidence of thromboischemic events in an unselected intracerebral hemorrhage and subarachnoid hemorrhage population was 31%. The overall incidence rates of deep vein thrombosis, pulmonary embolism, ischemic heart disease, and ischemic stroke after 6 months of intracerebral hemorrhage and subarachnoid hemorrhage onset were 10.9%, 5%, 10%, and 7.4%, respectively. The mean time to the events was 145.5 ± 5.5 days.

Age, smoking, hypertension, diabetes mellitus, and atrial fibrillation were the significant independent risk factors for thromboischemic events. Age, higher ICH score, Hunt & Hess grade, and hemorrhage size >30cc have shown significant correlations with the development of deep vein thrombosis.