Cerebral Amyloid Angiopathy and the Risk of Hematoma Expansion

Seiffge, David J; Polymeris, Alexandros; Law, Zhe Kang; Krishnan, Kailash; Zietz, Annaelle; Thilemann, Sebastian; Werring, David J.; Salman, Rustam Al‐Shahi; Dineen, Robert A.; Engelter, Stefan T.; Bath, Philip M.; Sprigg, Nikola; Lyrer, Philippe; Peters, Nils

doi:10.1002/ana.26481

Cited by 8 publications

(4 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results showed that the ICH score, GCS score, irregular shape, uneven density, IVH relation and surgery were related to the outcomes of intracranial hemorrhage patients. Some scholars have reported that intracranial hemorrhage patient prognosis is related to age, GCS score, blood pressure, hematoma location and volume [15,16], intraventricular hemorrhage, use of anticoagulation drugs, hematoma expansion [17] and some inflammatory factors [18], which is consistent with our results.…”

Section: Discussionsupporting

confidence: 92%

A Nomogram Model for Predicting Prognosis in Spontaneous Intracerebral Hemorrhage Patients

Li¹,

Liu²,

Wang³

et al. 2023

J. Integr. Neurosci.

View full text Add to dashboard Cite

Intracranial hemorrhage is the second most common stroke subtype following ischemic stroke and usually induces high mortality and disability. Here, we conducted a retrospective study to establish a nomogram clinical prediction model. Methods: First, the baseline data of patients who presented to our hospital in 2015-2021 were collected and compared (789 patients for the training cohort and 378 patients for the validation cohort). Second, univariate and binary logistic analyses were performed to screen out alternative indicators. Finally, a clinical prediction model by nomogram was established that included such indicators to estimate the prognosis of intracranial hemorrhage patients. Results: Univariate logistic analysis was used to screen several possible impact factors, including hypertension, hematoma volume, Glasgow Coma Scale (GCS) score, intracranial hemorrhage (ICH) score, irregular shape, uneven density, intraventricular hemorrhage (IVH) relation, fibrinogen, D-dimer, low density lipoprotein (LDL), high-density lipoprotein (HDL), creatinine, total protein, hemoglobin (HB), white blood cell (WBC), neutrophil blood cell (NBC), lymphocyte blood cell (LBC), the neutrophil lymphocyte ratio (NLR), surgery, deep venous thrombosis (DVT) or pulmonary embolism (PE) rate, hospital day, and hypertension control. Further binary logistic analysis revealed that ICH score (p = 0.036), GCS score (p = 0.000), irregular shape (p = 0.000), uneven density (p = 0.002), IVH relation (p = 0.014), surgery (p = 0.000) were independent indicators to construct a nomogram clinical prediction model. The C statistic was 0.840. Conclusions: ICH score, GCS score, irregular shape, uneven density, IVH relation, surgery are easily available indicators to assist neurologists in formulating the most appropriate therapy for every intracranial hemorrhage patient. Further large prospective clinical trials are needed to obtain more integrated and reliable conclusions.

show abstract

Section: Discussionsupporting

confidence: 92%

A Nomogram Model for Predicting Prognosis in Spontaneous Intracerebral Hemorrhage Patients

Li¹,

Liu²,

Wang³

et al. 2023

J. Integr. Neurosci.

View full text Add to dashboard Cite

show abstract

“…Dichotomising ICH location as either lobar or non-lobar may risk over-simplifying the underlying aetiology given that lobar ICH comprises CAA-related ICH, hypertensive arteriolopathy and mixed cerebral small vessel disease 18. Recently, a detailed secondary imaging analysis of TICH-2 demonstrated that in participants with lobar CAA-related ICH, there was an increased risk of haematoma expansion with increasing time from randomisation, while the risk of haematoma expansion was constant irrespective of baseline haematoma volume 19. These effects were not seen in those with non-CAA lobar or non-lobar ICH and may suggest a difference in haematoma dynamics between these ICH groups 19.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a detailed secondary imaging analysis of TICH-2 demonstrated that in participants with lobar CAA-related ICH, there was an increased risk of haematoma expansion with increasing time from randomisation, while the risk of haematoma expansion was constant irrespective of baseline haematoma volume 19. These effects were not seen in those with non-CAA lobar or non-lobar ICH and may suggest a difference in haematoma dynamics between these ICH groups 19. CAA-related bleeding may originate from leptomeningeal vessels and have more space to expand into (including the subarachnoid space), resulting in prolonged, slower, lower pressure bleeding over several hours 19.…”

Section: Discussionmentioning

confidence: 99%

“…These effects were not seen in those with non-CAA lobar or non-lobar ICH and may suggest a difference in haematoma dynamics between these ICH groups 19. CAA-related bleeding may originate from leptomeningeal vessels and have more space to expand into (including the subarachnoid space), resulting in prolonged, slower, lower pressure bleeding over several hours 19. This may potentially provide a longer treatment window for haemostatic agents including tranexamic acid to exert their effects.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of blood pressure and tranexamic acid in spontaneous intracerebral haemorrhage: a secondary analysis of a large randomised controlled trial

et al. 2023

Self Cite

View full text Add to dashboard Cite

BackgroundTranexamic acid reduced haematoma expansion and early death, but did not improve functional outcome in the tranexamic acid for hyperacute spontaneous intracerebral haemorrhage-2 (TICH-2) trial. In a predefined subgroup, there was a statistically significant interaction between prerandomisation baseline systolic blood pressure (SBP) and the effect of tranexamic acid on functional outcome (p=0.019).MethodsTICH-2 was an international prospective double-blind placebo-controlled randomised trial evaluating intravenous tranexamic acid in patients with acute spontaneous intracerebral haemorrhage (ICH). Prerandomisation baseline SBP was split into predefined ≤170 and >170 mm Hg groups. The primary outcome at day 90 was the modified Rankin Scale (mRS), a measure of dependency, analysed using ordinal logistic regression. Haematoma expansion was defined as an increase in haematoma volume of >33% or >6 mL from baseline to 24 hours. Data are OR or common OR (cOR) with 95% CIs, with significance at p<0.05.ResultsOf 2325 participants in TICH-2, 1152 had baseline SBP≤170 mm Hg and were older, had larger lobar haematomas and were randomised later than 1173 with baseline SBP>170 mm Hg. Tranexamic acid was associated with a favourable shift in mRS at day 90 in those with baseline SBP≤170 mm Hg (cOR 0.73, 95% CI 0.59 to 0.91, p=0.005), but not in those with baseline SBP>170 mm Hg (cOR 1.05, 95% CI 0.85 to 1.30, p=0.63). In those with baseline SBP≤170 mm Hg, tranexamic acid reduced haematoma expansion (OR 0.62, 95% CI 0.47 to 0.82, p=0.001), but not in those with baseline SBP>170 mm Hg (OR 1.02, 95% CI 0.77 to 1.35, p=0.90).ConclusionsTranexamic acid was associated with improved clinical and radiological outcomes in ICH patients with baseline SBP≤170 mm Hg. Further research is needed to establish whether certain subgroups may benefit from tranexamic acid in acute ICH.Trial registration numberISRCTN93732214.

show abstract

Tranexamic acid in a mouse model of cerebral amyloid angiopathy: setting the stage for a novel stroke treatment approach

Liu,

McCutcheon,

et al. 2023

Research and Practice in Thrombosis and Haemostasis

View full text Add to dashboard Cite

Cerebral Amyloid Angiopathy and the Risk of Hematoma Expansion

Cited by 8 publications

References 30 publications

A Nomogram Model for Predicting Prognosis in Spontaneous Intracerebral Hemorrhage Patients

A Nomogram Model for Predicting Prognosis in Spontaneous Intracerebral Hemorrhage Patients

Effects of blood pressure and tranexamic acid in spontaneous intracerebral haemorrhage: a secondary analysis of a large randomised controlled trial

Tranexamic acid in a mouse model of cerebral amyloid angiopathy: setting the stage for a novel stroke treatment approach

Contact Info

Product

Resources

About