Hematoma volume as the major determinant of outcomes after intracerebral hemorrhage

LoPresti, Melissa A.; Bruce, Samuel S.; Camacho, Elvis; Kunchala, Sudkir; DuBois, Byron G.; Bruce, Eliza; Appelboom, Geoff; Connolly, E. Sander

doi:10.1016/j.jns.2014.06.057

Cited by 117 publications

(75 citation statements)

References 64 publications

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“…Active bleeding is believed to last for minutes, supported by studies with radio-labeled erythrocytes injected into patients hours after ICH onset, revealing no change in hematoma activity after 2-5 h [27]. However, other studies have shown that while hematoma expansion is greatest in the subacute period, and HE can occur more than 6 h after onset, while no growth was observed between 24 and 48 h after onset [28]. Understanding the exact time frame of hematoma expansion, could help target interventions aiming to reduce growth and size.…”

Section: Discussionmentioning

confidence: 99%

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Intracerebral haemorrhage growth is influenced by anticoagulation intensity

Ye¹,

Leonid²,

Paltoglou³

et al. 2017

Neurol Disord Therap

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Background: Intracerebral hemorrhage (ICH) is a significant contributor to global health-related morbidity and mortality. Due to improved recognition and treatment of atrial fibrillation by antithrombotics, there is an increase in proportion of ICH caused by warfarin and novel oral anticoagulants. However, the relationship between anticoagulation intensity and hematoma expansion remains unclear. We aimed to investigate the effects of international normalized ratio (INR) on hematoma expansion post ICH.

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Section: Discussionmentioning

confidence: 99%

“…Several studies have also demonstrated that hematoma volume is a good predictor of long term mortality, beyond the acute period [28]. In addition, it is associated with poor functional outcome [18].…”

Section: Discussionmentioning

confidence: 99%

Intracerebral haemorrhage growth is influenced by anticoagulation intensity

Ye¹,

Leonid²,

Paltoglou³

et al. 2017

Neurol Disord Therap

View full text Add to dashboard Cite

show abstract

“…Third, other unmeasured characteristics may influence HE (e.g., APOE genotype [8] , malnutrition, hyperglycemia, admission blood pressure [8,35,36] ) and ICH outcome (e.g., hematoma sedimentation level [37] ). Third, the ABC/2 method may be less accurate than the semi-automated techniques [6,8] . Finally, the study was underpowered for estimation of mortality in those <65 years.…”

Section: Discussionmentioning

confidence: 99%

“…Other major ICH determinants include neurological impairment as assessed with the Glasgow Coma Scale (GCS), location and volume of hematoma and intraventricular extension of hemorrhage (IVH) [6,7] . Hematoma expansion (HE) also influences ICH prognosis and is of interest as a potentially treatable factor [6,8] .…”

Section: Introductionmentioning

confidence: 99%

The Effect of Age on Characteristics and Mortality of Intracerebral Hemorrhage in the Oldest-Old

et al. 2016

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Background: Incidence of acute intracerebral hemorrhage (ICH) increases with age, but there is a lack of information about ICH characteristics in the oldest-old (age ≥85 years). In particular, there is a need for information about hematoma volume, which is included in most clinical scales for prediction of mortality in ICH patients. Many of these scales also assume that, independent of ICH characteristics, the oldest-old have a higher mortality than younger elderly patients (age 65-74 years). However, supporting evidence from cohort studies is limited. We investigated ICH characteristics of oldest-old subjects compared to young (<65 years), young-old (65-74 years) and old-old (75-84 years) subjects. We also investigated whether age is an independent mortality predictor in elderly (age ≥65 years) subjects with acute ICH. Methods: We retrospectively collected clinical and neuroimaging data of 383 subjects (age 34-104 years) with acute supratentorial primary ICH who were admitted to an Italian Stroke Unit (SU) between October 2007 and December 2014. Measured ICH characteristics included hematoma location, volume and intraventricular extension of hemorrhage on admission CT scan; admission Glasgow Coma Scale ≤8 and hematoma expansion (HE) measured on follow-up CT-scans obtained after 24 h. General linear models and logistic models were used to investigate the association of age with ICH characteristics. These models were adjusted for pre-admission characteristics, hematoma location and time from symptom onset to admission CT scan. Limited to elderly subjects, Cox models were used to investigate the association of age with in-SU and 1-year mortality: the model for in-SU mortality adjusted for pre-admission and ICH admission characteristics and the model for 1-year mortality additionally adjusted for functional status and disposition at SU discharge. Results: Independent of pre-admission characteristics, hematoma location and time from symptom onset to admission CT-scan, oldest-old subjects had the highest admission hematoma volume (p < 0.01). Age was unrelated to all other ICH characteristics including HE. In elderly patients, multivariable adjusted risk of in-SU and 1-year mortality did not vary across age categories. Conclusions: Oldest-old subjects with acute supratentorial ICH have higher admission hematoma volume than young and young-old subjects but do not differ for other ICH characteristics. When taking into account confounding from ICH characteristics, risk of in-SU and 1-year mortality in elderly subjects with acute supratentorial ICH does not differ across age categories. Our findings question use of age as an independent criterion for stratification of mortality risk in elderly subjects with acute ICH.

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“…4 Hematoma expansion is associated with worse functional outcomes and increased mortality from ICH 4 although baseline hematoma volume remains the strongest determinant of outcome. 5 Risk factors for a higher risk of hematoma expansion include shorter time from onset to first brain imaging, large hematoma volume at presentation, decreased level of consciousness, coagulopathy, hyperglycemia, and heavy drinking. 6,7 Some, but not all, studies have shown association between hematoma expansion and severe acute hypertension or prior use of antiplatelet drugs.…”

mentioning

confidence: 99%