Risk factors for intracerebral haemorrhage – Results from a prospective population-based study

Svensson, Edith H.; Abul-Kasim, Kasim; Engström, Gunnar; Söderholm, Martin

doi:10.1177/2396987320932069

Cited by 10 publications

(5 citation statements)

References 43 publications

(62 reference statements)

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“…Apolipoprotein E (APOE)containing lipoproteins, such as high-density lipoproteins, mediate the inhibition of platelet function [13]. Recent publications also showed that apolipoproteins were related to hemorrhage [14,15]. However, no studies have been conducted on the effect of these gene polymorphisms on bleeding complications during DOAC treatment.…”

Section: Introductionmentioning

confidence: 99%

Association between Genetic Polymorphisms and Bleeding in Patients on Direct Oral Anticoagulants

et al. 2022

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Objectives: The purpose of our study is to investigate the effects of apolipoprotein B (APOB) and APOE gene polymorphisms on bleeding complications in patients receiving direct oral anticoagulants (DOACs). Methods: A total of 16 single nucleotide polymorphisms (SNPs) in 468 patients were genotyped. Six SNPs of ABCB1 (rs3842, rs1045642, rs2032582, rs1128503, rs3213619, and rs3747802), one SNP of CYP3A5 (rs776746), seven SNPs of APOB (rs1042034, rs2163204, rs693, rs679899, rs13306194, rs13306198, and rs1367117), and two SNPs of APOE (rs429358 and rs7412) were analyzed by a TaqMan genotyping assay. Multivariable logistic regression analysis with selected variables was performed for the construction of a risk scoring system. Two risk scoring systems were compared (demographic factors only vs. demographic factors and genetic factors). Results: In the multivariable analyses, two models were constructed; only demographic factors were included in Model I and both demographic factors and genetic factors in Model II. Rivaroxaban and anemia showed significant association with bleeding in both models. Additionally, ABCB1 rs3842 variant homozygote carriers (CC) and APOB rs13306198 variant allele carriers (AG, AA) had a higher risk of bleeding risk compared with that of wild-type allele carriers (TT, TC) and wild-type homozygote carriers (GG), respectively. Whereas the area under the receiver operating characteristic curve (AUROC) value using demographic factors only was 0.65 (95% confidence interval (CI): 0.56–0.74), the AUROC increased to 0.72 by adding genetic factors (95% CI: 0.65–0.80). The predicted bleeding risks of bleeding in patients with 0, 1, 2, 3, 4, 5, 6, 7 and 8 points from the logistic regression curve were 0.8%, 2.0%, 5.4%, 5.2%, 12.5%, 26.9%, 47.0%, 64.3% and 82.3%, respectively. Conclusions: The study results can be used for enhancing individualized treatment strategies in patients taking DOACs, helping clinicians predict the bleeding risk.

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Section: Introductionmentioning

confidence: 99%

Association between Genetic Polymorphisms and Bleeding in Patients on Direct Oral Anticoagulants

et al. 2022

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“…This finding was consistent with the results from a prospective population-based study in 2020, which showed that higher ApoB levels were significantly associated with a lower risk of ICH after multivariable adjustment (per 10-mg/dl increase, HR 0.94, 95% CI 0.90-0.99). 28 In addition, a report from the China Kadoorie Biobank involving approximately 5,000 ICH cases also showed inverse relationships between ApoB and ICH (RR 0.86, 95CI, 0.83-0.90), and between LDL-C and ICH (RR 0.86, 95% CI 0.80-0.92), 29 and the level of ApoB was confirmed to be closely related to the LDL levels. 29 However, in their MR study, only LDL-C was included as exposure, whereas ApoB was not considered, and a nonsignificant causal relationship was observed.…”

Section: Discussionmentioning

confidence: 94%

Lipids, Apolipoproteins, Statins, and Intracerebral Hemorrhage: A Mendelian Randomization Study

Zhou

Zhang

et al. 2022

Annals of Neurology

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Objective To investigate the causal role of lipid or apolipoprotein traits in intracerebral hemorrhage (ICH) and determine the effect of lipid‐lowering interventions on the disease. Methods Two‐sample Mendelian randomization (MR) analyses were conducted to evaluate the associations of high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol (LDL‐C), triglycerides (TG), apolipoprotein (Apo)B and ApoA1 levels with risks for ICH, and those of LDL‐C‐ (HMGCR, PCSK9, and NPC1L1) and TG‐lowering targets (LPL and APOC3) with ICH. Results Increased levels of ApoB was associated with a decreased risk of overall ICH (OR 0.623, 95% CI 0.413–0.940; p = 0.024) and lobar ICH (OR 0.579, 95% CI 0.342–0.979; p = 0.042). The inverse relationship remained stable in multivariable MR. In addition, elevated TGs showed a causal effect on lobar ICH in multivariable MR (OR 1.600, 95% CI 1.009–2.537; p = 0.046). The LDL‐C‐reducing genetic variation alleles at or near the HMGCR gene (mimicking the effect of statins) were predicted to increase the overall and deep ICH risk. Additionally, genetic variation at or near the APOC3 gene suggested that genetically reducing the activity of APOC3 (mimicking antisense anti‐apoC3 agents) was predicted to decrease lobar ICH. Interpretation Genetically predicted elevated ApoB may have a protective effect on overall ICH and lobar ICH, whereas elevated TG was associated with a higher risk of lobar ICH conditional on LDL‐C and ApoB. MR analysis supports the conclusion that statins may increase the risk of overall and deep ICH independent of their lipid‐lowering effect. More specific lipid‐lowering targets may end up being the future. ANN NEUROL 2022;92:390–399

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“…For patients with higher risk, it is recommended that the low-density lipoprotein should be reduced to less than 1.4, and too low cholesterol level and triglyceride will increase the risk of bleeding [23]. Relevant literature has mentioned that the reduction of ApoB or LDL-C is signi cantly correlated with the risk of cerebral hemorrhage [24][25][26]. On the other hand, statins themselves can directly interfere with the coagulation system and platelet activation [27].…”

Section: Discussionmentioning

confidence: 99%

New score models for predicting bleeding and ischemic of ticagrelor therapy in patients with diabetes mellitus

Xia,

Chen,

Cao

et al. 2024

Preprint

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Purpose Ticagrelor is an antiplatelet drug, and its use increases the risk of bleeding. Coronary artery disease is significantly influenced by the widespread occurrence of diabetes mellitus. In order to decrease the incidence of clinical adverse events, a novel bleeding and thrombosis score is developed in this research. Methods We conducted a retrospective analysis of patient data from two medical centers who were diagnosed with diabetes mellitus and treated with ticagrelor.We gathered information on every patient from the electronic database of the hospital and follow-up.The collected data were statistically analyzed to obtain risk factors for bleeding and ischemic events. Results A total of 851 patients with diabetes mellitus who have been administered ticagrelor are included in our investigation. A total of 76 patients have bleeding events and 80 patients have ischemic events. The analysis of multiple variables indicates that characteristics like the age of > 65, having a previous occurrence of bleeding, experiencing anemia, using aspirin, and taking atorvastatin are linked to a higher likelihood of bleeding. Additionally, the age of > 65, smoking, having a history of blood clots, and having a BMI ≥ 30 are found to increase the risk of ischemia. Conclusion The A4B score has been created by considering five risk factors. The A4B score outperforms the HAS-BLED score(AUC 0.714 vs 0.570).The ABST score has been created by considering four risk factors. The ABST score outperforms the CHA2DS-VASc score(AUC 0.708 vs 0.540). The novel risk-assessment model can potentially detect patients with a substantial likelihood of experiencing bleeding and ischemic events.(2023-09-11,ChiCTR2300075627)

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Risk factors for intracerebral haemorrhage – Results from a prospective population-based study

Cited by 10 publications

References 43 publications

Association between Genetic Polymorphisms and Bleeding in Patients on Direct Oral Anticoagulants

Association between Genetic Polymorphisms and Bleeding in Patients on Direct Oral Anticoagulants

Lipids, Apolipoproteins, Statins, and Intracerebral Hemorrhage: A Mendelian Randomization Study

New score models for predicting bleeding and ischemic of ticagrelor therapy in patients with diabetes mellitus

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