Department of Neurology, University of Duisburg-Essen, Essen, Germany.
Cerebrovasc Dis. 2011;32(3):283-8. doi: 10.1159/000330643. Epub 2011 Aug 31.
Recurrent stroke rates after intracerebral hemorrhage (ICH) vary widely between observational studies due to differences in ICH etiology and risk for thromboembolic events. We therefore aimed to assess the patient characteristics and prognosis after deep and lobar ICH in a well-characterized, multicenter, hospital-based cohort.
Patients were prospectively documented in 13 German neurological stroke centers. Of 744 patients with spontaneous ICH discharged alive, 516 (69.4%) gave informed consent and 496 (66.7%) could be followed up by central telephone interview over a mean duration of 2 years.
In patients with deep ICH, the Kaplan-Meier estimate for stroke during the first year was 5.8% (95% CI 2.9-8.7) and the overall annual rate (calculated over a 3-year period) was 2.9% (95% CI 1.6-4.1). In patients with lobar ICH, the Kaplan-Meier estimate for stroke during the first year was 7.8% (95% CI 3.1-12.5) and the overall annual rate was 7.2% (95% CI 3.8-10.6). At the last follow-up before recurrent stroke or end of study, 141 patients (28.4%) overall received antiplatelet agents, and 12 (2.4%) received oral anticoagulation. No difference could be found for recurrent ICH under antiplatelet agents versus no antithrombotic medication.
The risk of recurrent stroke after lobar ICH remains high beyond the first year, whereas it decreases after 1 year in patients with deep ICH. Antiplatelets are prescribed in a considerable number of patients even though the risk-benefit ratio after ICH remains unknown.
由于脑出血（ICH）的病因和血栓栓塞事件的风险不同，观察性研究中ICH 后的复发率差异很大。因此，我们旨在评估特征明确的多中心医院队列中深部和脑叶 ICH 患者的特征和预后。
13 家德国神经科卒中中心前瞻性地记录患者资料。744 例存活出院的自发性 ICH 患者中，516 例（69.4%）签署了知情同意书，496 例（66.7%）通过中心电话访谈进行了平均 2 年的随访。
在深部 ICH 患者中，第 1 年卒中的 Kaplan-Meier 估计值为 5.8%（95%CI 2.9-8.7），总体年发生率（3 年内计算）为 2.9%（95%CI 1.6-4.1）。在脑叶 ICH 患者中，第 1 年卒中的 Kaplan-Meier 估计值为 7.8%（95%CI 3.1-12.5），总体年发生率为 7.2%（95%CI 3.8-10.6）。在复发性卒中或研究结束前的最后一次随访中，总体有 141 例（28.4%）患者接受了抗血小板治疗，12 例（2.4%）患者接受了口服抗凝治疗。在抗血小板治疗与无抗血栓治疗的患者中，复发性 ICH 没有差异。
脑叶 ICH 后 1 年以上，复发性卒中的风险仍然很高，而深部 ICH 患者在 1 年后风险降低。尽管 ICH 后的风险效益比仍不清楚，但仍有相当数量的患者接受了抗血小板治疗。
