Antithrombotic medications and the etiology of intracerebral hemorrhage

Pezzini, Alessandro; Grassi, Mario; Paciaroni, Maurizio; Zini, Andrea; Silvestrelli, Giorgio; Zotto, Elisabetta Del; Caso, Valeria; Dell’Acqua, Maria Luisa; Giossi, Alessia; Volonghi, Irene; Simone, Anna Maria; Lanari, Alessia; Costa, Paolo; Poli, Loris; Morotti, Andrea; Giuli, Valeria De; Pepe, Daniele; Gamba, Massimo; Ciccone, Alfonso; Ritelli, Marco; Colombi, Marina; Agnelli, Giancarlo; Padovani, Alessandro

doi:10.1212/wnl.0000000000000108

Cited by 34 publications

(15 citation statements)

References 25 publications

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“…The reason for the similar rate of major bleeding events during PSM and DOAC is likely multifaceted. Although PSM is a high quality VKA treatment in terms of time in therapeutic range 14 , it is known that the majority of bleeding events occur within therapeutic range 30 . Furthermore, the rigorous monitoring of PSM patients likely results in improved adherence compared to patients receiving usual care with VKA or DOAC 31 .…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of self-managed oral anticoagulant therapy compared with direct oral anticoagulants in patients with atrial fibrillation

Grove

Skjøth

Nielsen

et al. 2018

Sci Rep

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We compared the effectiveness and safety of direct oral anticoagulants (DOAC) vs patient self-managed warfarin therapy (PSM) in patients with atrial fibrillation. We linked prospectively registered data from university hospital clinics to nationwide Danish health registries. Primary effectiveness and safety outcomes were ischaemic stroke (incl. systemic embolism) and major bleeding. All-cause mortality and all-cause stroke were secondary outcomes. An inverse probability of treatment propensity-weighted approach was applied to adjust for potential confounding. The study cohorts included 534 patients treated with PSM and 2,671 patients treated with DOAC. Weighted rates of ischaemic stroke were 0.46 and 1.30 percent per year with PSM vs DOAC, hazard ratio (HR) 0.27 (95% confidence interval 0.11–0.68) with 2.5 years follow-up. Rates of major bleeding were 2.32 and 2.13 percent per year (HR 1.06 [0.69–1.63]). All-cause mortality was not statistically different (HR 0.67 [0.39–1.17]), whereas the incidence of all-cause stroke was significantly lower among patients treated with PSM with rates of 0.61 vs 1.45 percent per year (HR 0.36 [0.16–0.78]). In patients with atrial fibrillation, self-managed oral anticoagulant treatment was associated with a significantly lower risk of all-cause and ischaemic stroke compared to treatment with DOAC, whereas no significant differences were observed for major bleeding and mortality.

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Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of self-managed oral anticoagulant therapy compared with direct oral anticoagulants in patients with atrial fibrillation

Grove

Skjøth

Nielsen

et al. 2018

Sci Rep

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“…One recent study found that anticoagulant medication was associated with increased risk of lobar but not non-lobar hemorrhage [ 10 ]. An older study reported similar findings [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Lobar and Non-Lobar Intracerebral Hemorrhage in Patients with Vascular Disease

et al. 2015

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IntroductionLobar and non-lobar non-traumatic intracerebral hemorrhage (ICH) are presumably caused by different types of small vessel diseases. The aim of this study was to assess risk factors for ICH according to location.MethodsIn two large prospective studies, SMART (n = 9088) and ESPRIT (n = 2625), including patients with manifest cardiovascular, cerebrovascular or peripheral artery disease or with vascular risk factors, we investigated potential risk factors for ICH during follow-up according to lobar or non-lobar location by Cox proportional hazards analyses.ResultsDuring 65,156 patient years of follow up 19 patients had lobar ICH (incidence rate 29, 95% CI 19–42 per 100,000 person-years) and 24 non-lobar ICH (incidence rate 37, 95% CI 26–51 per 100,000 person-years). Age significantly increased the risk of lobar ICH (HR per 10 years increase 1.90; 95% CI 1.17–3.10) in the multivariable analysis, but not of non-lobar hemorrhage. Anticoagulant medication (HR 3.49; 95% CI 1.20–10.2) and male sex (HR 3.79; 95% CI 1.13–12.8) increased the risk of non-lobar but not lobar ICH.ConclusionThis study shows an elevated risk of future ICH in patients with manifestations of, or risk factors for, cardiovascular, cerebrovascular or peripheral artery disease. Our data suggest that risk factors for ICH vary according to location, supporting the hypothesis of a differential pathophysiology of lobar and non-lobar ICH.

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“…Lobar and intraventricular hemorrhages were classified as secondary ICH because of the high frequency of associated vascular anomalies reported in Asian patients. 24 The demographic data of all the patients enrolled from SRICHS were documented. 25…”

Section: Methodsmentioning

confidence: 99%

Causes of Death in Different Subtypes of Ischemic and Hemorrhagic Stroke

et al. 2017

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Causes of death in both ischemic stroke (IS) and hemorrhagic stroke (HS) subtypes are not comprehensively studied. Between 2008 and 2011, we enrolled 11 215 first-ever stroke patients from the Stroke Registry of Chang-Gung Healthcare System and linked these data to the national death registry. The main causes of death in each stroke subtype were assessed. Patients with HS had higher overall mortality than IS (32.0% vs 18.1%, P < .001). In IS subtypes, large-artery atherosclerosis plus cardioembolism had the worst mortality (40.7%, P < .001). Stroke was the leading cause of death in both IS and HS within the first year. Stroke remained the major cause of death in HS, but cancer was the leading cause of death in IS after the first year. After excluding the patients with previous cancer history, cancer was still an important cause of death in IS and HS, particularly in the IS subtypes of small vessel occlusion, stroke of undetermined etiology, and transient ischemic attack.

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Antithrombotic medications and the etiology of intracerebral hemorrhage

Cited by 34 publications

References 25 publications

Effectiveness and safety of self-managed oral anticoagulant therapy compared with direct oral anticoagulants in patients with atrial fibrillation

Effectiveness and safety of self-managed oral anticoagulant therapy compared with direct oral anticoagulants in patients with atrial fibrillation

Risk Factors for Lobar and Non-Lobar Intracerebral Hemorrhage in Patients with Vascular Disease

Causes of Death in Different Subtypes of Ischemic and Hemorrhagic Stroke

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