We examined factors related to hematoma growth in 932 consecutive patients with intracerebral bleeding. Eighty-seven (9.3%) of patients had hematoma growth. The ratio of estimated hematoma volume in the second CT versus that in the first CT in patients with hematoma growth was 2.57±2.52 (mean±SD) times (range: 1.12–17.90 times). The modified Rankin Scale (mRS) at discharge in all patients was 0 (22 patients), 1 (33), 2 (90), 3 (182), 4 (149), 5 (371), and 6 (85).
Bivariate and multivariate analyses both showed that the incidence of hematoma growth was significantly higher in patients with internal administration of an antiplatelet drug, those with high prothrombin time-international normalized ratio (PT-INR), and those with concomitant development of liver disorders including hepatic dysfunction. The odds ratio for hematoma growth was 2.78 in patients with internal administration of an antiplatelet drug, 1.69 in those with high PT-INR, and 2.89 in those with concomitant development of liver disorders including hepatic dysfunction, showing that these factors would be closely related to hematoma growth. In addition, the mRS at discharge was significantly poor in aged patients, patients with a low Glasgow Coma Scale (GCS), those with high systolic arterial pressure, and those with concomitant development of renal disorders including renal dysfunction. Especially relevant was the odds ratio of poor mRS at discharge, which was 0.71 in GCS, and 3.52 in those with concomitant development of renal disorders including renal dysfunction. This suggests that these factors are highly related to low mRS at discharge.
When considering the potential development of intracerebral bleeding in the future, it will be desirable to administer an antithrombogenic drug only to patients for which it is essential. Concomitant administration of antiplatelet drugs and anticoagulants should be avoided as much as possible. When patients with concomitant development of hepatic dysfunction and renal dysfunction develop intracerebral bleeding, administration of an antithrombogenic drug should be minimized due to high risks of hematoma growth and poor prognosis.