Intracerebral hemorrhage risk in Alzheimer's disease patients on anticoagulants: A nationwide cohort study

BackgroundThe risk of intracerebral hemorrhage (ICH) in Alzheimer's disease (AD) patients undergoing anticoagulation (AC) remains unclear.ObjectiveThis nationwide cohort study assessed ICH risk in AC-treated AD patients.MethodsUsing Taiwan's National Health Insurance Research Database, we identified 1638 AC-treated AD patients and established four matched cohorts: AD with AC, AD without AC, non-AD with AC, and non-AD without AC. We applied inverse probability of treatment weighting (IPTW) and competing risks regression (CRR) to adjust for confounders and mortality risk. Cox proportional hazards regression estimated ICH risk.ResultsThe ICH incidence per 100 person-years was 2.21 in AD patients with AC, 1.03 without AC, 1.71 in non-AD with AC, and 0.28 in non-AD without AC. After IPTW adjustment, compared to non-AD without AC, AD patients with AC had the highest ICH risk (aHR 1.94, 95% CI: 1.44-2.61), followed by non-AD with AC (aHR 1.84, 95% CI: 1.51-2.23) and AD without AC (aHR 1.74, 95% CI: 1.42-2.11). ICH risk in AC-treated AD patients was comparable to non-AD with AC. Subgroup analysis showed higher ICH risk in females and those with hyperlipidemia, diabetes, heart failure, chronic kidney disease, or cancer.ConclusionsAD is associated with increased ICH risk, which is further elevated by AC use. These findings highlight the need for individualized risk-benefit evaluation, particularly in high-risk populations.