Cardioembolic Stroke Risk and Recovery After Anticoagulation-Related Intracerebral Hemorrhage
Year: 2018
Type: article
Abstract: Background and Purpose— Whether to resume oral anticoagulation treatment after intracerebral hemorrhage (ICH) remains an unresolved question. Previous studies focused primarily on recurrent stroke after ICH. We sought to investigate the association between cardioembolic stroke risk, oral anticoagulation therapy resumption, and functional recovery among ICH survivors in the absence of recurrent stroke. Methods— We conducted a joint analysis of 3 observational studies: (1) the multicenter RETRACE study (German-Wide Multicenter Analysis of Oral Anticoagulation Associated Intracerebral Hemorrhage); (2) the Massachusetts General Hospital ICH study (n=166); and (3) the ERICH study (Ethnic/Racial Variations of Intracerebral Hemorrhage; n=131). We included 941 survivors of ICH in the setting of active oral anticoagulation therapy for prevention of cardioembolic stroke because of nonvalvular atrial fibrillation and without evidence of ischemic stroke and recurrent ICH at 1 year from the index event. We created univariable and multivariable models to explore associations between cardioembolic stroke risk (based on CHA 2 DS 2 -VASc scores) and functional recovery after ICH, defined as achieving modified Rankin Scale score of ≤3 at 1 year for participants with modified Rankin Scale score of >3 at discharge. Results— In multivariable analyses, the CHA 2 DS 2 -VASc score was associated with a decreased likelihood of functional recovery (odds ratio, 0.83 per 1 point increase; 95% CI, 0.79–0.86) at 1 year. Anticoagulation resumption was independently associated with a higher likelihood of recovery, regardless of CHA 2 DS 2 -VASc score (odds ratio, 1.89; 95% CI, 1.32–2.70). We found an interaction between CHA 2 DS 2 -VASc score and anticoagulation resumption in terms of association with increased likelihood of functional recovery (interaction P =0.011). Conclusions— Increasing cardioembolic stroke risk is associated with a decreased likelihood of functional recovery at 1 year after ICH, but this association was weaker among participants resuming oral anticoagulation therapy. These findings support, including recovery metrics, in future studies of anticoagulation resumption after ICH.
Source: Stroke
Authors: Meredith P. Murphy, Joji B. Kuramatsu, Audrey Leasure, Guido J. Falcone, Hooman Kamel, Lauren H. Sansing, Christina Kourkoulis, Kristin Schwab, Jordan J. Elm, M. Edip Gurol, Huy Tran, Steven M. Greenberg, Anand Viswanathan, Christopher D. Anderson, Stefan Schwab, Jonathan Rosand, Fu-Dong Shi, Steven J. Kittner, Fernando D. Testai, Daniel Woo, Carl D. Langefeld, Michael L. James, Sebastian Koch, Hagen B. Huttner, Alessandro Biffi, Kevin N. Sheth
Institutions: Massachusetts General Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Yale University, Weill Cornell Medicine, Medical University of South Carolina, University of New Mexico, Barrow Neurological Institute, University of Maryland, Baltimore, Baltimore VA Medical Center, University of Illinois Chicago, University of Cincinnati, Wake Forest University Health Sciences, Wake Forest University, Duke University
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Awards: Anticoagulation in ICH Survivors for Prevention and Recovery (ASPIRE), Center for Common Disease Genetics, Precision Medicine in Ischemic Stroke and Atrial Fibrillation (PreMISe-AF), Apathy and Depression following Intracerebral Hemorrhage, ERICH-GENE, Molecular Neuroimaging of Disease Mechanisms in Cerebral Amyloid Angiopathy, Vascular Dysfunction in Cerebral Amyloid Angiopathy, Sequencing Annotation and Functional Analysis in Risk of Intracerebral Hemorrhage, Efferocytosis and the resolution of inflammation after intracerebral hemorrhage, Platform for Accelerating Genetic Discovery for Cerebrovascular Disease, The Recovery in Stroke Using PAP (RISE UP) Study, Specialized Programs of Translational Research in Acute Stroke at the Partners, Yale Clinical Site: Investigations For Improved Neurological Treatments at Yale (INFINITY), Dynamic Neuroimmune Profiling in Patients with Acute Intracerebral Hemorrhage, Race / Ethncicity, Hypertension and Prevention of VCID and Stroke after Intracerebral Hemmorrhage, Southern New England Partnership In Stroke Research, Innovation and Treatment (SPIRIT), Claude D. Pepper Older Americans Independence Center at Yale, Genetic Analyses of Lipids in Cerebral Hemorrhage and Small Vessel Disease
OpenAlex ID: W2896253390