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.