Sensitivity and specificity of blood-fluid levels for oral anticoagulant-associated intracerebral haemorrhage

Almarzouki, A. et al. (2020) Sensitivity and specificity of blood-fluid levels for oral anticoagulant-associated intracerebral haemorrhage. Scientific Reports, 10, 15529. (doi: 10.1038/s41598-020-72504-7) (PMID:32968133) (PMCID:PMC7511300)

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Intracerebral haemorrhage (ICH) is a life-threatening emergency, the incidence of which has increased in part due to an increase in the use of oral anticoagulants. A blood-fluid level within the haematoma, as revealed by computed tomography (CT), has been suggested as a marker for oral anticoagulant-associated ICH (OAC-ICH), but the diagnostic specificity and prognostic value of this finding remains unclear. In 855 patients with CT-confirmed acute ICH scanned within 48 h of symptom onset, we investigated the sensitivity and specificity of the presence of a CT-defined blood-fluid level (rated blinded to anticoagulant status) for identifying concomitant anticoagulant use. We also investigated the association of the presence of a blood-fluid level with six-month case fatality. Eighteen patients (2.1%) had a blood-fluid level identified on CT; of those with a blood-fluid level, 15 (83.3%) were taking anticoagulants. The specificity of blood-fluid level for OAC-ICH was 99.4%; the sensitivity was 4.2%. We could not detect an association between the presence of a blood-fluid level and an increased risk of death at six months (OR = 1.21, 95% CI 0.28–3.88, p = 0.769). The presence of a blood-fluid level should alert clinicians to the possibility of OAC-ICH, but absence of a blood-fluid level is not useful in excluding OAC-ICH.

Item Type:Articles
Additional Information:A correction to this article is available at
Glasgow Author(s) Enlighten ID:Muir, Professor Keith
Authors: Almarzouki, A., Wilson, D., Ambler, G., Shakeshaft, C., Cohen, H., Yousry, T., Salman, R. A.-S., Lip, G. Y.H., Houlden, H., Brown, M. M., Muir, K. W., Jäger, H. R., and Werring, D. J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Neuroscience and Psychology
Journal Name:Scientific Reports
Publisher:Nature Research
ISSN (Online):2045-2322
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Scientific Reports 10: 15529
Publisher Policy:Reproduced under a Creative Commons License
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