Optimization of risk stratification for anticoagulation-associated intracerebral hemorrhage: net risk estimation.

MedStar author(s):
Citation: Journal of Neurology. 267(4):1053-1062, 2020 Apr.PMID: 31848737Institution: MedStar Washington Hospital CenterDepartment: Surgical Critical CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Anticoagulants/ae [Adverse Effects] | *Cerebral Hemorrhage/ci [Chemically Induced] | *Cerebral Hemorrhage/ep [Epidemiology] | *Ischemic Stroke/dt [Drug Therapy] | *Ischemic Stroke/ep [Epidemiology] | *Risk Assessment/st [Standards] | *Severity of Illness Index | Aged | Aged, 80 and over | Cohort Studies | Female | Humans | MaleYear: 2020Local holdings: Available online from MWHC library: 1997 - presentISSN:
  • 0340-5354
Name of journal: Journal of neurologyAbstract: BACKGROUND: Every anticoagulation decision has in inherent risk of hemorrhage; intracerebral hemorrhage (ICH) is the most devastating hemorrhagic complication. We examined whether combining ischemic and hemorrhagic stroke risk in individual patients might provide a meaningful paradigm for risk stratification.CONCLUSIONS: In this anticoagulation-associated ICH cohort, baseline hemorrhagic risk exceeded ischemic risk in approximately 50%, highlighting the importance of careful consideration of risk/benefit ratio prior to anticoagulation decisions. The remaining 50% suffered an ICH despite excess baseline ischemic risk, stressing the need for biomarkers to allow more precise estimation of hemorrhagic complication risk.METHODS: We enrolled consecutive patients with anticoagulation-associated ICH in 15 tertiary centers in the USA, Europe and Asia between 2015 and 2017. Each patient was assigned baseline ischemic stroke and hemorrhage risk based on their CHA2DS2-VASc and HAS-BLED scores. We computed a net risk by subtracting hemorrhagic from ischemic risk. If the sum was positive the patient was assigned a "Favorable" indication for anticoagulation; if negative, "Unfavorable".RESULTS: We enrolled 357 patients [59% men, median age 76 (68-82) years]. 31% used non-vitamin K antagonist (NOAC). 191 (53.5%) patients had a favorable indication for anticoagulation prior to their ICH; 166 (46.5%) unfavorable. Those with unfavorable indication were younger [72 (66-80) vs 78 (73-84) years, p = 0.001], with lower CHA2DS2-VASc score [3(3-4) vs 5(4-6), p < 0.001]. Those with favorable indication had a significantly higher prevalence of most cardiovascular risk factors and were more likely to use a NOAC (35% vs 25%, p = 0.045). Both groups had similar prevalence of hypertension and chronic kidney disease.All authors: Alexandrov AV, Boviatsis E, Chang J, Goyal N, Karapanayiotides T, Kargiotis O, Katsanos AH, Krogias C, Lioutas VA, Malhotra K, Mehta C, Mitsias PD, Paciaroni M, Palaiodimou L, Pandhi A, Schroeder C, Selim MH, Serdari A, Sharaf A, Sharma VK, Tsantes A, Tsivgoulis G, Vadikolias K, Varelas P, Zand ROriginally published: Journal of Neurology. 2019 Dec 17Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2020-01-03
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 31848737 Available 31848737

Available online from MWHC library: 1997 - present

BACKGROUND: Every anticoagulation decision has in inherent risk of hemorrhage; intracerebral hemorrhage (ICH) is the most devastating hemorrhagic complication. We examined whether combining ischemic and hemorrhagic stroke risk in individual patients might provide a meaningful paradigm for risk stratification.

CONCLUSIONS: In this anticoagulation-associated ICH cohort, baseline hemorrhagic risk exceeded ischemic risk in approximately 50%, highlighting the importance of careful consideration of risk/benefit ratio prior to anticoagulation decisions. The remaining 50% suffered an ICH despite excess baseline ischemic risk, stressing the need for biomarkers to allow more precise estimation of hemorrhagic complication risk.

METHODS: We enrolled consecutive patients with anticoagulation-associated ICH in 15 tertiary centers in the USA, Europe and Asia between 2015 and 2017. Each patient was assigned baseline ischemic stroke and hemorrhage risk based on their CHA2DS2-VASc and HAS-BLED scores. We computed a net risk by subtracting hemorrhagic from ischemic risk. If the sum was positive the patient was assigned a "Favorable" indication for anticoagulation; if negative, "Unfavorable".

RESULTS: We enrolled 357 patients [59% men, median age 76 (68-82) years]. 31% used non-vitamin K antagonist (NOAC). 191 (53.5%) patients had a favorable indication for anticoagulation prior to their ICH; 166 (46.5%) unfavorable. Those with unfavorable indication were younger [72 (66-80) vs 78 (73-84) years, p = 0.001], with lower CHA2DS2-VASc score [3(3-4) vs 5(4-6), p < 0.001]. Those with favorable indication had a significantly higher prevalence of most cardiovascular risk factors and were more likely to use a NOAC (35% vs 25%, p = 0.045). Both groups had similar prevalence of hypertension and chronic kidney disease.

English

Powered by Koha