Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Intracerebral Hemorrhage in Multiple Sclerosis

J Stroke Cerebrovasc Dis; ePub 2018 Oct 29; Zulfiger, et al

Tobacco exposure and anticoagulant use were strongly associated with increased risk of intracerebral hemorrhage (ICH) in patients with multiple sclerosis (MS), according to a recent study. Therefore, there might be a protective effect that antiplatelet and disease-modifying drugs (DMDs) have in the pathophysiology of this disease. Researchers conducted an observational, retrospective cohort study using the nationwide electronic medical records (EMR) database. Patients with the diagnosis of MS were extracted from inpatient and outpatient EMR. They excluded patients aged <18 years, and those where gender was not specified. Patients were further stratified based on their demographics, risk factors, medications, and comorbidities. Tobacco, diabetes, hypertension, and alcohol were the predicting variables; antiplatelet medication, and anticoagulant agents were the primary exposures for the development of ICH. They found:

  • Of the total 57,099 MS patients (women: 75%, n=41,517), 107 (.19%) sustained an ICH.
  • Age, use of anticoagulants, and history of tobacco exposure were associated with increased risk of ICH.
  • Use of antiplatelet and DMDs showed a protective trend against ICH.


Zulfiger M, Qeadan F, Ikram A, et al. Intracerebral hemorrhage in multiple sclerosis: A retrospective cohort study. [Published online ahead of print October 29, 2018]. J Stroke Cerebrovasc Dis. doi:10.1016/j.jstrokecerebrovasdis.2018.09.050.