Key result
Among 46 anticoagulated patients with atrial fibrillation who died from intracranial hemorrhage, 78.3% had spontaneous bleeding, of which 77.8% demonstrated neuroradiological evidence of hypertensive vasculopathy.
Why the study?
Hypertension is a major modifiable risk factor for intracranial haemorrhage in patients with AF receiving oral anticoagulation, prompting an assessment of the prevalence of poorly controlled hypertension among those who died from intracranial haemorrhage.
Is poorly controlled hypertension (hypertensive vasculopathy) a major underlying aetiology of spontaneous intracranial haemorrhage-related mortality in patients with atrial fibrillation receiving oral anticoagulation?
Cohort (n=46)
No
Is poorly controlled hypertension (hypertensive vasculopathy) a major underlying aetiology of spontaneous intracranial haemorrhage-related mortality in patients with atrial fibrillation receiving oral anticoagulation?
Absolute Event Rate: 77.8% vs 0%
p-value: p=<0.001
Hypertensive vasculopathy is a major underlying cause of spontaneous intracranial haemorrhage-related mortality in anticoagulated patients with atrial fibrillation, emphasizing the critical need for strict blood pressure control.
Poor BP control associated with ICH mortality in anticoagulated AF; hypothesis-generating and requires prospective validation before practice implications.
Study objective Hypertension is a major modifiable risk factor for intracranial haemorrhage (ICH) in patients with atrial fibrillation (AF) receiving oral anticoagulation (OAC). We performed a retrospective exploratory analysis of the prevalence of poorly controlled hypertension, as evidenced by hypertensive vasculopathy on neuroimaging, among patients with AF on OAC who died after presenting with ICH at a large district general hospital in England. Methods Between December 2020 and April 2024, the death registry data of a large district general hospital in the South East of England, United Kingdom, were analysed to identify patients who were anticoagulated for AF and who had ICH as the primary cause of their death. The confirmatory neuroimaging data were interrogated to assess the likely underlying cause of bleeding. Results Of the 5,452 deaths within the study period, 46 patients on OAC for AF were included. The majority of patients (78.3%) had spontaneous ICH compared to traumatic ICH (11.7%). Most patients (84.8%) recorded hypertension (80% in the traumatic group, n = 8 vs. 86.1% in spontaneous ICH, n = 31). In those with spontaneous ICH, 28 (77.8%) demonstrated neuroradiological evidence of bleeding as a result of hypertensive vasculopathy. Conclusion Hypertension is not only a major substrate of AF incidence but a cause of additional morbidity and mortality. Within our cohort, hypertensive vasculopathy was a significant underlying aetiology of spontaneous ICH-related mortality. Falls and trauma causing ICH in anticoagulated patients with AF may be overestimated. In line with the recently updated European Society of Cardiology (ESC) guideline, blood pressure should take priority in the management of AF to reduce major bleeding risk.
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Kim et al. (2026) conducted a cohort in Atrial fibrillation with intracranial haemorrhage (n=46). Spontaneous intracranial haemorrhage vs. Traumatic intracranial haemorrhage was evaluated on Radiological prediction of hypertensive vasculopathy as the likely underlying aetiology (p=<0.001). Among 46 anticoagulated patients with atrial fibrillation who died from intracranial hemorrhage, 78.3% had spontaneous bleeding, of which 77.8% demonstrated neuroradiological evidence of hypertensive vasculopathy.
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