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Iatrogenic intracerebral hemorrhage (ICH) is one of the most feared complications of anticoagulation for patients and physicians and can result in significant morbidity and mortality. The overall incidence of oral anticoagulant–related ICH (OAC-ICH) is 0.3% to 1.8% of patients per year who are taking warfarin.1 Most of the literature to date has outlined the bleeding risks of warfarin. Many OAC-related factors affect the incidence rate of ICH, including the intensity of anticoagulation, age, concomitant medical problems, duration of treatment, race, and higher risk of primary brain hemorrhage. Although the rate appears low, OAC-ICH (using conventional anticoagulation with warfarin) carries a 50% mortality rate. Given that warfarin can be associated with substantial variability in the international normalized ratio (INR) and resultant high-risk situations of supratherapeutic INR, there is a clinical need for safer approaches to anticoagulation that provide similar protection against stroke but at a lower complication rate.
Vespa PM. Oral Anticoagulants and the Risk of Intracranial Hemorrhage. JAMA. 2014;312(23):2562-2563. doi:10.1001/jama.2014.12180