Anemia and stroke: Where do we stand?

Kaiafa, Georgia; Savopoulos, Christos; Kanellos, Ilias; Mylonas, Konstantinos S.; Tsikalakis, G.; Tegos, Thomas; Kakaletsis, Nikolaos; Hatzitolios, Apostolos

doi:10.1111/ane.12657

Cited by 50 publications

(58 citation statements)

References 51 publications

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“…Anemia is also a suspected cardiovascular factor [ 19 , 20 ]. Anemia is considered a hyperkinetic state, and it disturbs endothelial adhesion molecule genes, which may lead to thrombus formation.…”

Section: Discussionmentioning

confidence: 99%

“Recurrent multiple cerebral infarctions related to the progression of adenomyosis: a case report”

et al. 2018

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BackgroundBenign gynecologic tumor, such as uterine adenomyosis, has been suggested to develop hypercoagulability. Although some cases of cerebral infarction associated with adenomyosis have been reported, the mechanism of hypercoagulation initiated by adenomyosis is still not clear, and the therapeutic strategy is uncertain.Case presentationA 44-year-old woman was presented to our department with headache, left hand weakness, and gait disturbance during her menstrual phase. She had a history of adenomyosis and infertility treatment for 18 years and heavy menstrual bleeding. Magnetic resonance imaging on admission showed multiple hyperintense lesions in cortical and subcortical areas in the cerebrum and cerebellum on diffusion-weighted imaging. Transesophageal echocardiography showed neither embolic sources nor existence of foramen ovale. Her laboratory data revealed anemia, a high D-dimer level, and elevated levels of a mucinous tumor marker. She had adenomyosis and no malignancy was detected. Anticoagulation therapy with intravenous heparin followed by rivaroxaban did not prevent recurrence of cerebral infarction. We discontinued rivaroxaban, and started warfarin therapy with pseudomenopause treatment, which prevented recurrence for 6 months. Five months after her last pseudomenopause treatment, multiple cerebral infarctions occurred. Total hysterectomy was performed, which prevented recurrence of the multiple cerebral infarctions for 2 years without anticoagulation therapy.ConclusionsOur findings reveal for the first time that anticoagulation therapy, including novel oral anticoagulants, had no preventive effect against cerebral infarctions associated with adenomyosis in a middle-aged woman. Although pseudomenopause treatment temporarily prevented recurrence, resection of the adenomyosis might be the most effective therapy in these cases.

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Section: Discussionmentioning

confidence: 99%

“Recurrent multiple cerebral infarctions related to the progression of adenomyosis: a case report”

et al. 2018

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“…Iron deficiency has also been shown to induce secondary thrombocytosis in several clinical settings. Correction of iron deficiency usually lowers platelet count and platelet activation in patients with chronic kidney disease, cancer or inflammatory bowel disease‐associated secondary thrombocytosis, and may contribute to reduced risk of thrombo embolic events .…”

Section: Should We Treat Iron Deficiency Without Anaemia?mentioning

confidence: 99%

An international consensus statement on the management of postoperative anaemia after major surgical procedures

Múñoz

Acheson

Bisbe³

et al. 2018

Anaesthesia

173

190

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Despite numerous guidelines on the management of anaemia in surgical patients, there is no pragmatic guidance for the diagnosis and management of anaemia and iron deficiency in the postoperative period. A number of experienced researchers and clinicians took part in a two-day expert workshop and developed the following consensus statement. After presentation of our own research data and local policies and procedures, appropriate relevant literature was reviewed and discussed. We developed a series of best-practice and evidence-based statements to advise on patient care with respect to anaemia and iron deficiency in the postoperative period. These statements include: a diagnostic approach to iron deficiency and anaemia in surgical patients; identification of patients appropriate for treatment; and advice on practical management and follow-up that is easy to implement. Available data allow the fulfilment of the requirements of Pillar 1 of Patient Blood Management. We urge national and international research funding bodies to take note of these recommendations, particularly in terms of funding large-scale prospective, randomised clinical trials that can most effectively address the important clinical questions and this clearly unmet medical need.

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“…In patients with ischaemic and haemorrhagic stroke, the presence of anaemia has been found to be associated with poor clinical outcome [6,7]. One proposed mechanism is that low haemoglobin levels impair oxygen delivery to the damaged brain and induce an inflammatory response [8]. Data from a recent singlecentre study suggest that an association between anaemia and poor clinical outcome also exists in CVT, but this study had a limited sample size [9].…”

Section: Introductionmentioning

confidence: 97%

Anaemia at admission is associated with poor clinical outcome in cerebral venous thrombosis

Silvis

Reinstra

Hiltunen

et al. 2020

Euro J of Neurology

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Background and purpose Anaemia is associated with poor clinical outcome after ischaemic and haemorrhagic stroke. The association between anaemia and outcome in patients with cerebral venous thrombosis (CVT) was examined. Methods Consecutive adult patients with CVT were included from seven centres. Anaemia at admission was scored according to World Health Organization definitions. Poor clinical outcome was defined as a modified Rankin Scale score 3–6 at last follow‐up. A multiple imputation procedure was applied for handling missing data in the multivariable analysis. Using binary logistic regression analysis, adjustments were made for age, sex, cancer and centre of recruitment (model 1). In a secondary analysis, adjustments were additionally made for coma, intracerebral haemorrhage, non‐haemorrhagic lesion and deep venous system thrombosis (model 2). In a sensitivity analysis, patients with cancer were excluded. Results Data for 952 patients with CVT were included, 22% of whom had anaemia at admission. Patients with anaemia more often had a history of cancer (17% vs. 7%, P < 0.001) than patients without anaemia. Poor clinical outcome (21% vs. 11%, P < 0.001) and mortality (11% vs. 6%, P = 0.07) were more common amongst patients with anaemia. After adjustment, anaemia at admission increased the risk of poor outcome [adjusted odds ratio (aOR) 2.4, 95% confidence interval (CI) 1.5–3.7, model 1]. Model 2 revealed comparable results (aOR 1.9, 95% CI 1.2–3.2), as did the sensitivity analysis excluding patients with cancer (aOR 2.3, 95% CI 1.3–3.8, model 1). Conclusion The risk of poor clinical outcome is doubled in CVT patients presenting with anaemia at admission.

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Anemia and stroke: Where do we stand?

Cited by 50 publications

References 51 publications

“Recurrent multiple cerebral infarctions related to the progression of adenomyosis: a case report”

“Recurrent multiple cerebral infarctions related to the progression of adenomyosis: a case report”

An international consensus statement on the management of postoperative anaemia after major surgical procedures

Anaemia at admission is associated with poor clinical outcome in cerebral venous thrombosis

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