Intracranial Hemorrhage in Cancer Patients: Clinical Characteristics and Outcomes in Oncologic ICU

Introduction: Intracranial hemorrhage (ICH) in cancer patients presents therapeutic challenges due to thrombocytopenia, coagulopathy, and treatment-related risks. This study aimed to characterize clinical features, bleeding patterns, and outcomes of this population.


Methods: We retrospectively reviewed 110 adult cancer patients with ICH admitted to ICU between April 2016 and September 2020. Data included demographics, cancer type/treatment, coagulation profile, hemorrhagic characteristics, transfusions, complications, and outcomes. Statistical analyses included chi-square, t-test, logistic regression, and ROC analysis.


Results: Median age was 58.5 years; 64.6% were male and 72.7% White. Median GCS was 15 (13–15), and ECOG was 1 (0–2). Common comorbidities included hypertension (56%), smoking (27%), and diabetes (23%). Melanoma (28%), leukemia (25%), and glioblastoma (14%) were most prevalent. Recurrent disease occurred in 63%; 80 % received chemotherapy, 40% radiation, and 32% both.

Lobar hemorrhages were most common (43%), followed by infratentorial (29%), subdural (15%), deep (14%), and multifocal/diffuse (14%). Intraventricular hemorrhage occurred in 12% and external ventricular drain placed in 7%. Anticoagulant and antiplatelet use were 16% and 9%. Median platelet count was 148 x 109/L (32–229), INR 1.13 (1.04-1.33); 46% received transfusions. Infections occurred in 32%, primarily pneumonia (23%).

Platelet count < 15 × 10⁹/L was associated with lower survival (p = 0.004) and shorter ICU-to-death interval (51 vs. 143 days, p = 0.016). The optimal cutoff was 15 × 10⁹/L (AUC = 0.81). Grouped bleed location (lobar, subdural, subarachnoid, multifocal/metastatic) was not significantly associated with survival. Platelet transfusion did not improve survival in those with profound thrombocytopenia.

Hospital survival was 76%. Of those discharged, 48% returned home, 14% entered hospice, and 9% discharged to rehabilitation. Post-discharge mortality was 77% with median ICU-to-death of 43 days (17–126).


Conclusions: ICH in cancer patients is associated with high transfusion needs, infection risk, and poor long-term outcomes. Profound thrombocytopenia ( < 15 × 10⁹/L) was a strong predictor of early mortality. These findings support the use of hemostatic thresholds to inform ICU triage and goals-of-care discussions.