Is intracranial hemorrhage increased in cirrhosis?: An autopsy-based case control study

Abstract

Background: Patients with cirrhosis are perceived to be at increased risk for bleeding given the presence of coagulopathy leading to unnecessary head imaging studies. Our aim is to determine the prevalence of intracranial hemorrhage (ICH) in patients with cirrhosis using gold standard autopsy data. Methods: An autopsy-based case control study was performed in a tertiary care hospital with a specialized Liver Unit. Autopsies without both head and abdominal examinations were excluded. Results: Between 1986 and 2003, a total of 679 autopsies were performed. 37 autopsies were excluded and 642 autopsies were available for final review. A total of 21 (4.3%) patients in the cirrhosis group had ICH compared to 12 (7.9%) patients in the control group (p = 0.115). Since Alzheimer’s patients may be at higher risk for ICH given the presence of cerebral amyloid angiopathy, a separate analysis was performed after excluding these patients. The results were similar (4.3% vs. 9.3%, p = 0.061). The prevalence of old strokes (1.2% vs. 13.9%, p < 0.001), acute strokes (0% vs. 4%, p < 0.001), and Alzheimer’s disease (1% vs. 29.1%, p < 0.001) were found to be higher in the control group compared to the cirrhosis group. Conclusion: Despite the presence of coagulopathy, patients with cirrhosis are at no increased risk for intracranial bleeding compared to controls without cirrhosis.

Keywords

• cirrhosis
• intracranial hemorrhage
• autopsy
• alzheimer’s disease