Phenylpropanolamine contained in cold remedies and risk of hemorrhagic stroke

Yoon, Byung Woo; Bae, Hee Joon; Hong, Kyung Soon; Lee, S. M.; Park, B. J.; Yu, K. H.; Han, Moon Ku; Lee, Y. S.; Chung, D. K.; Park, J. M.; Jeong, Sang-Wuk; Lee, B. C.; Cho, K. H.; Kim, J. S.; Lee, S. H.; Yoo, K. M.

doi:10.1212/01.wnl.0000250351.38999.f2

Cited by 56 publications

(44 citation statements)

References 6 publications

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“…[18][19][20] Cold remedies or appetite suppressants containing phenylpropanolamine have also been suggested to increase the risk of HS. 13,[21][22][23] In the stratified analysis according to coffee intake, the group that did not drink coffee daily had a significantly higher risk of HS compared with those who frequently drank coffee. The finding of a higher OR among persons with a lower daily intake of caffeine makes sense because users develop tachyphylaxis to caffeine.…”

Section: Discussionmentioning

confidence: 94%

“…Furthermore, the neurologists were blinded to the drug exposure information when they evaluated potential cases according to predefined criteria. 13,24 Second, we collected drug exposure data directly from our study participants. Most of the CCMs are available at pharmacies without a prescription, whereas only a few needs a physician's prescription; therefore, we were able to collect information on prescribed and nonprescribed CCMs.…”

Section: Discussionmentioning

confidence: 99%

“…We ascertained a history of exposure to medication for all prescribed and nonprescribed drugs and collected information related to drug brand names, generic names, indications, the first date of administration, dose, and duration. 13 …”

Section: Data Collectionmentioning

confidence: 99%

“…13 Patients who had experienced a HS, and who were aged 30 to 84 years and able to complete an interview, were recruited sequentially from 33 hospitals in Korea between 2002 and 2004. This study was approved by the Seoul National University Hospital/Seoul National University College of Medicine institutional review board, and all study participants provided written informed consent to participate.…”

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confidence: 99%

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Caffeine-Containing Medicines Increase the Risk of Hemorrhagic Stroke

Lee

Choi²,

Lee

et al. 2013

Stroke

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The multicenter, matched case-control study data collected for the acute brain bleeding analysis were used. 13 Patients who had experienced a HS, and who were aged 30 to 84 years and able to complete an interview, were recruited sequentially from 33 hospitals in Korea between 2002 and 2004. This study was approved by the Seoul National University Hospital/Seoul National University College of Medicine institutional review board, and all study participants provided written informed consent to participate.Background and Purpose-Research on the relationship between caffeine-containing medicines (CCMs) and the risk of hemorrhagic stroke (HS) is sparse. The aim of this study is to evaluate the association between CCMs and the risk of HS. Methods-We performed a multicenter case-control study in South Korea, from 2002 to 2004. A total of 940 patients with nontraumatic acute HS, aged 30 to 84 years without a history of stroke, 940 community, and 940 hospital controls, age and sex matched to each case, were included. We obtained information on all medications taken in the 14 days before the date (index date) and time of stroke onset (zero-time) for case subjects or matched zero-time for control subjects. Exposure to CCMs was defined by use on the index date before zero-time or during the preceding 3 days. The adjusted odds ratios and their 95% confidence intervals (CIs) were estimated by conditional logistic regression. Results-The adjusted odds ratio for the association between the use of CCM and risk for HS was 2.23 (95% CI, 1. 41-3.69) for all HS, 2.24 (95% CI, 1.08-4.66) for subarachnoid hemorrhage, and 2.49 (95% CI, 1.29-4.80) for intracerebral hemorrhage. Stratified by daily coffee intake, adjusted odds ratio of CCMs for HS was 2.95 (95% CI, 1.45-5.98) for those who did not drink coffee on a daily basis. Conclusions-These results suggest that use of CCMs is associated with increased risk of HS, both subarachnoid hemorrhage and intracerebral hemorrhage. Identification of CasesWe screened all of the patients with HS admitted to the participating hospitals. HS was defined as either SAH or ICH. The diagnosis of SAH was based on clinical symptoms plus either a brain image (computed tomography [CT], MRI) or evidence of xanthochromia on a lumbar puncture. ICH was diagnosed on the basis of clinical symptoms and detection of blood in the brain parenchyma or ventricles by CT or MRI. Study eligibility criteria included ages ranging from 30 to 84 years, absence of a history of stroke or hemorrhage-prone brain lesions, no causal relationship of the stroke to trauma, and the ability to communicate and complete an interview within 30 days after the onset of the stroke. For each patient, we identified the zero-time as the calendar day (ie, index date) and the time of day that marked the onset of symptoms that were plausibly related to hemorrhage and that caused the patient to seek medical attention. 14 We defined the zero-time after considering the symptoms of hemorrhage, including paralysis, vertigo, disorders of memory, epile...

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

mentioning

confidence: 99%

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Caffeine-Containing Medicines Increase the Risk of Hemorrhagic Stroke

Lee

Choi²,

Lee

et al. 2013

Stroke

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“…Participants The Acute Brain Bleeding Analysis Study is a multicentre project designed to produce a nationwide, large, prospective and reliable haemorrhagic stroke registry in Korea [6]. Between October 2002 and March 2004, a consecutive series of patients with haemorrhagic stroke (ICH, n=1,604; subarachnoid haemorrhage, n=1,106) were registered in 33 medical centres.…”

Section: Methodsmentioning

confidence: 99%

Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: the Acute Brain Bleeding Analysis Study

et al. 2009

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Aims/hypothesis Admission hyperglycaemia is associated with a poor outcome in patients with ischaemic stroke. However, its prognostic effects after intracerebral haemorrhage (ICH) are still unclear. Methods We prospectively enrolled patients with ICH at 33 centres in Korea between October 2002 and March 2004. A total of 1,387 patients who had ICH and underwent brain computed tomography within 48 h of symptom onset were included in the study (n=1,387). Clinical information and radiological findings were collected at admission. Glucose levels were examined in relation to early (up to 30 days after ictus) and long-term (after 30 days) mortality rates using Cox regression analysis. To eliminate short-term effects, long-term mortality rate analysis was performed on surviving patients for more than 30 days. Results The long-term mortality rate was 21.1% after a mean follow-up of 434.3±223.2 days and was found to increase significantly with glucose quartile (p<0.001). Admission glucose level was an independent risk factor for early mortality (per mmol/l; adjusted HR 1.10 [95% CI 1.01-1.19]), but not for long-term mortality. Moreover, when analysis was restricted to patients without diabetes, glucose level was found to be an independent risk factor for post-ICH mortality (n=1,119; adjusted HR 1.10 [95% CI 1.03-1.17]) and had marginal significance for early (p= 0.053) and long-term mortality (p=0.09). Conclusions/interpretation We found that admission glucose levels were associated with early mortality after ICH. In patients without diabetes, admission glucose levels were associated with long-term mortality. We therefore suggest that intensive lowering of glucose level should be further investigated in ICH patients.

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What caused this intracerebral hemorrhage?

Radmanesh

Rosand

2019

Warlow's Stroke

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Phenylpropanolamine contained in cold remedies and risk of hemorrhagic stroke

Cited by 56 publications

References 6 publications

Caffeine-Containing Medicines Increase the Risk of Hemorrhagic Stroke

Caffeine-Containing Medicines Increase the Risk of Hemorrhagic Stroke

Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: the Acute Brain Bleeding Analysis Study

What caused this intracerebral hemorrhage?

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