The combination of warfarin use and the spot sign leads to detrimental outcomes in patients with intracerebral hematomas.

•The in-hospital mortality of the combination of warfarin use and spot sign-present in intracerebral hemorrhage was 52.2%.•The mortality of this combination was significantly higher than the other patient groups.•The combination of warfarin use and spot sign-present was also a predictor of both hematoma enlargement and death.•The combination of warfarin use and spot sign-present should be regarded as high-risk patients.