Long-term mortality after intracerebral hemorrhage

Flaherty, Matthew L.; Haverbusch, Mary; Sekar, Padmini; Kissela, Brett M.; Kleindorfer, Dawn; Moomaw, Charles J.; Sauerbeck, Laura; Schneider, Alexander; Broderick, Joseph P.; Woo, Daniel

doi:10.1212/01.wnl.0000208400.08722.7c

Cited by 367 publications

(251 citation statements)

References 28 publications

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“…In that trial, patient with haematomas located at one centimetre or less from the cortical surface fared better if operated. As it is show in this series and in others studies 10 , deep-seated ICH has a much worse outcome than superficial 12,16 and this difference may have therapeutic implications. Although deep-seated location is the most frequent location in most population-based studies 9,10,11 , this was not the case in the present study.…”

Section: Early Mortality In Spontaneous Supratentorial Intracerebral supporting

confidence: 70%

Early mortality in spontaneous supratentorial intracerebral haemorrhage

et al. 2010

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SummaryBackground. Spontaneous supratentorial intracerebral haemorrhage is a severe, frequent, and poorly understood condition. Despite the publication of 12 randomised controlled trials on this subject, the role of surgery remains controversial and no treatment has proved to be effective. We report on a ten year prospective cohort study based on a defined population treated with or without surgery and their outcome in terms of early survival.Methods. Population based, ten year prospective observational study directed to patients consecutively admitted to the Intensive Care Unit (ICU) in a tertiary centre with spontaneous supratentorial intracerebral haemorrhage. Patients were distributed in five groups according to the Glasgow Coma Score (GCS) at admission. Haemorrhages were classified as deep-seated or superficial. All patient received standard medical care, and additionally surgery if it was found indicated by the duty neurosurgeon. Primary endpoint was early mortality defined as dead occurred by any cause during the admission in the ICU.Findings. During the ten year period, 1.485 patients were admitted to our centre with primary intracerebral haemorrhage. Of these, 376 were admitted to the intensive care unit and 285 sustained supratentorial haemorrhages. Low GCS was strong predictor of early mortality. Despite the larger size of haematomas in patients undergoing surgical evacuation, surgery was associated with lower early mortality in all GCS subgroups. Maximal benefit was observed in patient with admission GCS of 4-8. Superficial haematomas were operated on more often, and were associated with lower mortality rate than deep-seated cases.Conclusions. Our findings suggest that craniotomy for haematoma evacuation may reduce early mortality in patients with primary supratentorial intracerebral haemorrhage. Surgery seems specially useful in patients with admission GCS between 4 and 8, and in those with superficial haemorrhages.

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Section: Early Mortality In Spontaneous Supratentorial Intracerebral supporting

confidence: 70%

Early mortality in spontaneous supratentorial intracerebral haemorrhage

et al. 2010

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“…Ischemic stroke and acute myocardial infarction share many features [36]. In both cases, the time to reperfusion is a crucial factor in determining outcome.…”

Section: Discussionmentioning

confidence: 99%

Acute stroke intervention by interventional cardiologists

DeVries

White

Collins

et al. 2009

Cathet Cardio Intervent

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Objectives: To report the technical success and clinical outcomes of catheter-based therapy (CBT) for acute ischemic stroke in patients ineligible for intravenous thrombolysis. Background: Acute ischemic stroke is common but undertreated. CBT for acute ischemic stroke is a therapeutic option in selected patients who are not candidates for intravenous thrombolysis. Methods: Consecutive stroke patients who were ineligible for intravenous thrombolysis and underwent CBT were identified by retrospective chart review. Demographic information, National Institutes of Health Stroke Scale (NIHSS), procedural characteristics, and clinical outcomes during hospitalization and at 90 days follow up were collected. Experienced interventional cardiologists with the consultative support of stroke neurologists were on call for acute strokes. Results: A total of 33 acute ischemic stroke patients underwent emergency cerebral angiography, with 26 patients undergoing CBT. Successful ' 'culprit' ' artery recanalization was achieved in 23 (88%) of the 26 patients. In-hospital adverse events occurred in 4 (15%) patients, with intracerebral hemorrhage (ICH) (12%) representing the most common adverse event. The baseline NIHSS for patients who underwent intervention was 16.5 6 9.9 (median 16) and improved significantly to 9.9 6 8.7 (median 9) (P < 0.001) at hospital discharge. A modified Rankin score of two or less (indicating mild disability) was achieved in half (n 5 13) of the CBT treated patients. All cause mortality at 90 days was 8% (2/26). Conclusions: In selected patients, CBT provided by qualified interventional cardiologists supported by stroke neurologists, offers a safe and effective option for patients with acute stroke who are not eligible for intravenous thrombolysis. '

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“…Whenever the model required data that could not be retrieved from the Hokusai-VTE trial, transition probabilities were derived from publications; these data included the probability of developing CTEPH [10] and PTS [11] after a VTE event, the probability of disability following ICH [12], some disease-specific mortality rates (due to a PE recurrence [13], the probability of dying when disabled from ICH [14], and short-term [15] and long-term mortality [16] from CTEPH), and the probability of developing rVTE while off treatment [17] (Table 2). The general mortality of the cohort depended on the gender distribution and mean age across the time horizon.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of edoxaban compared to warfarin for the treatment and secondary prevention of venous thromboembolism in the UK

Clay

Jamotte

Verhamme

et al. 2018

Journal of Market Access & Health Policy

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Background: Venous thromboembolism (VTE), which includes pulmonary embolism (PE) and deep vein thrombosis (DVT), is the third most common acute cardiovascular disease and represents an important burden for patients and payers.Objective: The aim was to estimate the cost-effectiveness of edoxaban, a non-VKA oral anticoagulant vs. warfarin, the currently most prescribed treatment for VTE in the UK.Study design: A Markov model was built using data from the Hokusai-VTE randomised controlled trial to estimate the lifetime costs and quality-adjusted life years (QALYs) in patients with VTE treated with edoxaban or warfarin over a lifetime horizon, from the UK National Health Services perspective. The model included VTE recurrences, VTE-related complications (post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension), and several types of bleeds associated with anticoagulation treatment. Patients were treated during a period of 6 months after the first VTE event, followed by flexible treatment duration (from 6 months to lifetime) after recurrence, i.e., tertiary prevention.Results: Edoxaban was found dominant vs. warfarin with 0.033 additional QALY and £55 less costs. The reduction of patient management costs, specifically monitoring costs, outweighed the higher drug costs. Edoxaban was dominant in all subgroups (index DVT only, all PE cases (PE with or without DVT), PE without DVT and PE with DVT). Cost-savings ranged from £54 to £81 while additional QALYs ranged from 0.031 to 0.046. Edoxaban was found dominant in 88.6% of cases and cost-effective in additional 10.9% of cases considering a £20,000 threshold in the probabilistic sensitivity analysis.Conclusion: Edoxaban may improve patients’ quality of life in a lifetime horizon without additional costs for the healthcare system due to lower bleeding risk and no monitoring cost compared to warfarin.

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Long-term mortality after intracerebral hemorrhage

Abstract: Intracerebral hemorrhage (ICH) mortality did not improve significantly between study periods. Operation for ICH became less frequent, whereas anticoagulant-associated ICH became more common.

Cited by 367 publications

References 28 publications

Early mortality in spontaneous supratentorial intracerebral haemorrhage

Early mortality in spontaneous supratentorial intracerebral haemorrhage

Acute stroke intervention by interventional cardiologists

Cost-effectiveness of edoxaban compared to warfarin for the treatment and secondary prevention of venous thromboembolism in the UK

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