Intracerebral hemorrhage score in patients with spontaneous intracerebral hemorrhage pretreated and not treated with antithrombotics

Background One of the validated prognostication models for predicting 30-day mortality in spontaneous intracerebral hemorrhage patients is the intracerebral hemorrhage score. Aim To assess the prognostic value of the intracerebral hemorrhage score in patients treated or not with antithrombotic drugs. Methods We analyzed clinical and imaging data of 170 patients (82 males) consecutive patients admitted to a non-teaching Italian hospital with spontaneous intracerebral hemorrhage. We calculated and compared the intracerebral hemorrhage score of patients who were pre-treated with vitamin K antagonists or antiplatelet agents with those who were not. In-hospital mortality was our endpoint. Results Thirty-three patients were on vitamin K antagonists, 67 on antiplatelet agents, and 66 were on neither. Overall, in-hospital mortality was 35.8% and significantly higher in patients on vitamin K antagonists (59.4%) or on antiplatelet agents (41.7%) than in those who were not on these medications (20.6%; p=0.0001 for trend)). Median intracerebral hemorrhage score was 2 in patients with vitamin K antagonists, 2 for patients on antiplatelet agents, and 1 for non-treated patients. The intracerebral hemorrhage score predicted in-hospital mortality in all three subgroups accurately. However, patients on vitamina K antagonists and antiplatelet agents showed significantly higher mortality rates at intracerebral hemorrhage score ≤3, compared to non-treated patients (39%, 28.3% and 10%, respectively). Conclusion The intracerebral hemorrhage score has good predictive value in patients on or off antithrombotic agents. However, for scores ≤ 3, the intracerebral hemorrhage score significantly underestimates in-hospital mortality in patients on antithrombotic agents.