Changes in the occurrence of and risk factors for hemophilia‐associated intracranial hemorrhage

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Abstract
Recent studies suggest that rates of intracranial hemorrhage (ICH) increased concomitant with the HIV epidemic among the hemophilia population, but no studies have directly examined factors associated with ICH. To determine ICH rates and identify factors associated with ICH, we performed a nested case–control study of a cohort composed of all hemophilic males identified by a surveillance system. Data were obtained from medical records of care received during 1993–1997. Patients with ICH listed in hospital records or on death certificates during the 5-year period were compared to the remainder of the cohort to examine associations between ICH and patients' demographic and clinical factors including the presence of HIV infection. Among the 3,269 males in the cohort, 88 (2.7%) had an ICH during follow-up, an average incidence rate of 0.0054 case/year. Hemorrhage sites were intracerebral for 37.5%, subdural for 34.1%, unspecified for 19.3%, subarachnoid for 12.5%, and epidural for 8% of cases. For 22% of cases, the ICH was trauma-related, and, overall, 16 patients (18.2%) died. Several factors were independently associated with ICH (odds ratio, P value): severe disease (2.0, 0.05); age 51+ years compared to 6–10 year olds (3.7, 0.02); presence of an inhibitor (3.5, <0.001); and HIV infection among whites only (4.0, <0.001). ICH rates in our cohort were 2-fold higher compared to rates from previous reports. Much of the increase was attributed to HIV infection, which raised ICH risk primarily in whites and was frequently associated with spontaneous ICH among older individuals. Am. J. Hematol. 68:37–42, 2001. Published 2001 Wiley-Liss, Inc.