Furthermore, with bedside genotyping available, there would be room of optimization of acute management of ICH by the combination use of island sign and the APOE gene, in terms of risk stratification and an early bundle of care focused on blood pressure control (30), individualized anti-coagulation strategy for patients at high thromboembolic risk including atrial fibrillation, venous thromboembolism, etc. (1). Here, APOE is linked to atrial fibrillation.