Anticoagulant Related Intracerebral Hemorrhage Diagnosis

Computerized tomography (CT) remains the initial neuroimaging tool of choice for acute Intracranial Hemorrhage Diagnosis ¹⁾.

The presence of a blood-fluid level has been suggested as a marker for Anticoagulant Related Intracerebral Hemorrhage ^{2) 3)}, but with the exception of one study (a sub-study of INTERACT 2), most published studies are case reports or were done on small samples ^{4) 5)}

In a study of 2065 patients from the INTERACT-2 study, blood-fluid levels on baseline CT (found in 19 patients in the sample) were associated with the use of warfarin as well as poor outcome 90 days after ICH ⁶⁾.

In 855 patients with CT-confirmed acute ICH scanned within 48 h of symptom onset, Almarzouki et al. investigated the sensitivity and specificity of the presence of a CT-defined blood-fluid level (rated blinded to anticoagulant status) for identifying concomitant anticoagulant use. They also investigated the association of the presence of a blood-fluid level with six-month case fatality. Eighteen patients (2.1%) had a blood-fluid level identified on CT; of those with a blood-fluid level, 15 (83.3%) were taking anticoagulants. The specificity of the blood-fluid level for OAC-ICH was 99.4%; the sensitivity was 4.2%. They could not detect an association between the presence of a blood-fluid level and an increased risk of death at six months (OR = 1.21, 95% CI 0.28-3.88, p = 0.769). The presence of a blood-fluid level should alert clinicians to the possibility of OAC-ICH, but the absence of a blood-fluid level is not useful in excluding OAC-ICH ⁷⁾.