Waimei Tai, MD
Huhtakangas J, Löppönen P, Tetri S, Juvela S, Saloheimo P, Bode MK, et al. Predictors for Recurrent Primary Intracerebral Hemorrhage: A Retrospective Population-Based Study. Stroke.  STROKEAHA.112.671230. Published online before print January 17, 2013.

Recently Huhtakangas et. al. in Finland published an interesting study on independent predictors for recurrent hemorrhage. They found that prior history of ischemic stroke was a strong predictive factor in having hemorrhage (HR 2.22 95% CI 1.22-4.05). Diabetes also suggested a trend towards hemorrhage but confidence interval reached below 1. Wellcontrolled hypertension was correlated with less likelihood of hemorrhage. 

Given the large national registry data that Finland has, this study had robust medication history and was able to explore previous work which suggested an interaction with SSRIs (selective serotonin reuptake inhibitors) and the signal of increased hemorrhage risk. Fortunately, this study did not find any additional suspicion that this widely prescribed class of medications was associated with additional hemorrhage risk.

This paper is useful in that it suggests patients who need SSRI’s ought not to fear about a possible increased risk of intracranial hemorrhage. This paper does suggest that for those with prior history of stroke, prevention of future hemorrhage is a good reason to be even more aggressive with diabetes management.