Alghamdi Abdulaziz M, Alkulli Osama A, Fatani Feras, Subahi Fahad S, Tayeb Abdullah F, Alghamdi Arwa, Alzahrani Moajeb, Almehmadi Fahad
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.
Research Office, King Abdullah International Medical Research Center, Jeddah, SAU.
Cureus. 2025 Apr 22;17(4):e82813. doi: 10.7759/cureus.82813. eCollection 2025 Apr.
Atrial fibrillation (Afib) requires anticoagulation to prevent strokes; however, it concurrently increases the risk of bleeding, including intracranial hemorrhage (ICH). Balancing thromboembolism prevention with bleeding risk is challenging, and guideline variations add uncertainty. Evaluating patient factors and ICH management is key to optimizing treatment and outcomes.
This is a retrospective cohort study conducted in King Abdulaziz Medical City in Jeddah, Saudi Arabia. This design is particularly well-suited for studying rare events like ICH, as it enables the inclusion of a larger sample size over an extended time period without the need for a long follow-up. Patients were identified through medical records of those with Afib on anticoagulation who developed ICH, confirmed by brain CT. The primary endpoint was to evaluate the management, outcome, and prognosis of ICH in these patients. The secondary endpoint was to assess the association between clinicopathological features and in-hospital mortality.
A total of 36 patients were included in this study. Patients who were ≥ 70 years old accounted for 52.7%, and males constituted 61.1% of the patients. Spontaneous ICH was seen in 72.2%, while the rest were traumatic in origin. Conservative management was done in 80.5%; 69.4% had their Afib medication ceased upon admission, and only 66.6% of those had their Afib medications resumed. The factors associated with mortality during hospital admission included higher BMI (30.2 (26.3-33.1) vs. 25.1 (22.1-29.2), P = 0.0255), diabetes (14 (82.3%) vs. 8 (42.1%), P = 0.0134), higher International Normalized Ratio (INR) (1.8 (1.2-2) vs. 1.2 (1.1-1.3), P = 0.0356), spontaneous ICH (15 (88.2%) vs. 11 (57.8%), P = 0.0425), and Glasgow Coma Scale (GCS) ≤ 8 (15 (88.2%) vs. 4 (21.0%), P = 0.0002). Regarding the outcome, 47.2% passed away during their hospital stay. Upon discharge, 78.9% had a GCS score of ≥ 14; apixaban was the most common medication prescribed (42.1%). The follow-up periods of the discharged patients had a median of 445 days; 33.3% passed away, while only 5.5% of them developed a recurrent ischemic stroke.
Our findings revealed that ICH in Afib patients is associated with high mortality and overall poor prognosis. There is a clear need for standardized management guidelines. Further studies are essential to establish evidence-based recommendations and reach reliable conclusions to improve patient outcomes.
心房颤动（房颤）需要抗凝治疗以预防中风；然而，它同时会增加出血风险，包括颅内出血（ICH）。平衡血栓栓塞预防与出血风险具有挑战性，且指南的差异增加了不确定性。评估患者因素和ICH管理是优化治疗及改善预后的关键。
这是一项在沙特阿拉伯吉达阿卜杜勒阿齐兹国王医疗城进行的回顾性队列研究。这种设计特别适合研究像ICH这样的罕见事件，因为它能够在较长时间段内纳入更大样本量，而无需长时间随访。通过对抗凝治疗的房颤患者发生ICH且经脑部CT证实的患者的病历进行识别。主要终点是评估这些患者中ICH的管理、结局和预后。次要终点是评估临床病理特征与住院死亡率之间的关联。
本研究共纳入36例患者。年龄≥70岁的患者占52.7%，男性占患者总数的61.1%。72.2%为自发性ICH，其余为创伤性ICH。80.5%采用保守治疗；69.4%的患者入院时停用了房颤药物，其中只有66.6%的患者恢复了房颤药物治疗。与住院期间死亡率相关的因素包括较高的体重指数（BMI）（30.2（26.3 - 33.1）对25.1（22.1 - 29.2），P = 0.0255）、糖尿病（14例（82.3%）对8例（42.1%），P = 0.0134）、较高的国际标准化比值（INR）（1.8（1.2 - 2）对1.2（1.1 - 1.3），P = 0.0356）、自发性ICH（15例（88.2%）对11例（57.8%），P = 0.0425）以及格拉斯哥昏迷量表（GCS）≤8（15例（88.2%）对4例（21.0%），P = 0.0002）。关于结局方面有47.2%的患者在住院期间死亡。出院时，78.9%的患者GCS评分≥14；阿哌沙班是最常用的处方药物（42.1%）。出院患者的随访期中位数为445天；33.3%的患者死亡，而只有5.5%的患者发生复发性缺血性中风。
我们的研究结果显示，房颤患者的ICH与高死亡率和总体不良预后相关。显然需要标准化的管理指南。进一步的研究对于建立基于证据的建议并得出可靠结论以改善患者结局至关重要。
