Recurrent Intracerebral Hemorrhage: Associations with Comorbidities and Medicine with Antithrombotic Effects

Schmidt, Linnea Boegeskov; Goertz, Sanne; Wohlfahrt, Jan; Melbye, Mads; Munch, Tina Nørgaard

doi:10.1371/journal.pone.0166223

Cited by 39 publications

(32 citation statements)

References 35 publications

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“…This is consistent with a few previous studies that were conducted on patients with ICH that found that recurrence of ICH increases with time of follow up. 61,62 A review by Endres and colleagues summarized the studies that investigated statin use and ICH recurrence and concluded that there is no evidence that statin increased risk of ICH recurrence. 63…”

Section: Discussionmentioning

confidence: 99%

Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis

Teoh¹,

Huang

Chan

et al. 2019

Ther Adv Neurol Disord

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Background: It remains debatable whether statin increases the risk of intracerebral hemorrhage (ICH) in poststroke patients. Methods: We systematically searched PubMed, EMBASE, and CENTRAL for randomized controlled trials. Trial sequential analysis (TSA) was conducted to assess the reliability and conclusiveness of the available evidence in the meta-analysis. To evaluate the overall effectiveness, the net composite endpoints were derived by totaling ischemic stroke, hemorrhagic stroke, transient ischemic attack (TIA), myocardial infarction, and cardiovascular mortality. Results: A total of 17 trials with 11,576 subjects with previous ischemic stroke, TIA, or ICH were included, in which statin therapy increased the risk of hemorrhagic stroke (risk ratio [RR], 1.42; 95% confidence interval [CI], 1.07–1.87), but reduced the risk of ischemic stroke (RR, 0.85; 95% CI, 0.75–0.95). For the net composite endpoints, statin therapy was associated with a 17% risk reduction (95% CI, 12–21%; number needed to treat = 6). With a control event rate 2% and RR increase 40%, the TSA suggested a conclusive signal of an increased risk of hemorrhagic stroke in stroke survivors taking statin. However, with the sensitivity analysis by changing assumptions, the conclusions about hemorrhagic stroke risk were less robust. Conclusions: Statin therapy in poststroke patients increased the risk of hemorrhagic stroke but effectively reduced ischemic stroke risk. Weighing the benefits and potential harms, statin has an overall beneficial effect in patients with previous stroke or TIA. However, more studies are required to investigate the conclusiveness of the increased hemorrhagic stroke risk revealed in our study.

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Section: Discussionmentioning

confidence: 99%

Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis

Teoh¹,

Huang

Chan

et al. 2019

Ther Adv Neurol Disord

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“…4 Studies of chronic antiplatelet use after ICH have hitherto mainly focused on ICH recurrence risk. [5][6][7][8][9][10][11] It is unclear how use of antiplatelets after HS influences long-term overall mortality irrespective of use before HS. This is of particular interest since patients on antiplatelet drugs might discontinue this therapy after suffering an ICH; further, patients with both ICH 12,13 and SAH [14][15][16] are reported to be at increased long-term risk of mortality due to cardiovascular and cerebrovascular events other than recurrence of the index event.…”

Section: Introductionmentioning

confidence: 99%

Low-Dose Aspirin after an Episode of Haemorrhagic Stroke Is Associated with Improved Survival

González‐Pérez¹,

Garcı́a-Dorado²,

Abajo³

et al. 2017

Thromb Haemost

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We aimed at investigating how antiplatelet drug use affected mortality in patients with a history of haemorrhagic stroke (HS). Thus, starting 30 days after an HS episode, we followed 1,004 patients with intracerebral haemorrhage (ICH) and 929 patients with subarachnoid haemorrhage (SAH) for a median of 6.4 years. We estimated the effect of time-dependent exposure to antiplatelets after HS on all-cause mortality. Cox proportional hazard models were used to compute adjusted hazard ratios (aHRs) and 95% confidence intervals (CI). We found that current use of low-dose aspirin was associated with a 32% improved survival (aHR = 0.68; 95% CI: 0.53–0.88), with a similar association among ICH (aHR = 0.66; 95% CI: 0.49–0.89) and SAH (aHR = 0.61; 95% CI: 0.36–1.04) patients. A statistically significant improved survival associated with current use of low-dose aspirin during follow-up was only observed among individuals who used antithrombotic drugs in the year before the HS (prior use: aHR = 0.56; 95% CI: 0.39–0.80; non-prior use: aHR = 0.87; 95% CI: 0.61–1.24). Current use of clopidogrel was not associated with survival (aHR = 1.35; 95% CI: 0.88–2.08). Statin use was associated with improved survival (aHR = 0.38; 95% CI: 0.31–0.47). On the other hand, discontinuation of statins (aHR = 1.31; 95% CI: 1.02–1.68) or low-dose aspirin (aHR = 1.54; 95% CI: 1.21–1.97) was associated with decreased survival. In our study, use of low-dose aspirin after an episode of HS to reduce vascular risks is safe, particularly in patients who were on antithrombotic therapy before the episode. Our results suggest an improved survival associated with low-dose aspirin. This finding must be interpreted with care due to the observational nature of the study, and warrants further studies.

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“…A meta-analysis reported an annual risk of recurrence after spontaneous ICH between 1.3-7.4%, but most of these studies started follow-up at 30 or 90 days after the hemorrhage. 238 One recent study investigating recurrence up to 5 years after primary ICH reported the cumulative recurrence risk of ICH after 28 days being 3.67% (95% CI 3.37-3.97), 239 which is comparable to many ischemic stroke studies.…”

Section: Discussionmentioning

confidence: 64%

Incidence and Etiologies of Stroke Mimics After Incident Stroke or Transient Ischemic Attack

Khanevski

Kvistad

Novotný

et al. 2019

Stroke

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Background and Purpose— Stroke mimics (SM) pose a common clinical challenge, but the burden of SM in patients with previous ischemic stroke (IS) or transient ischemic attack is unknown. The objective of this study was to calculate the incidence of SM in IS survivors, compare it with the incidence of recurrent stroke in the same population, and explore the time-dependent patterns of SM etiologies. Methods— This prospective cohort study registered SM events and etiologies among 1872 IS and transient ischemic attack survivors diagnosed with index stroke at Haukeland University Hospital stroke unit from 2007 to 2013 by review of medical records. Cumulative incidences of SM were estimated with a competing risks Cox model and compared with incidence of recurrent stroke in the same population. Results— During 8172 person-years of follow-up, 339 patients had 480 SM events. The cumulative incidence rate of SM during follow-up was 58.7 per 1.000 person-years (95% CI, 53.7–64.2) compared with 34.0 per 1.000 person-years (95% CI, 30.2–38.2) for recurrent stroke in the same time period. The risks of SM and recurrent stroke were highest the first year after index IS or transient ischemic attack. The most frequent SM diagnoses were sequelae of cerebral infarction (19.8%), medical observation, and evaluation for suspected cerebrovascular disease (15.6%) and infections (14.0%). The 2 most frequent and unspecific diagnoses (sequelae of cerebral infarction and medical observation) were clustered in the first months after index stroke. Conclusions— SM after IS or transient ischemic attack are more frequent than recurrent stroke and the risk is especially high in the early period. SMs are multietiological and unspecific diagnoses are most frequent early after index stroke.

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Recurrent Intracerebral Hemorrhage: Associations with Comorbidities and Medicine with Antithrombotic Effects

Cited by 39 publications

References 35 publications

Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis

Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis

Low-Dose Aspirin after an Episode of Haemorrhagic Stroke Is Associated with Improved Survival

Incidence and Etiologies of Stroke Mimics After Incident Stroke or Transient Ischemic Attack

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