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Lee TC, Leung WC, Ho C, Chiu MW, Leung IY, Wong YK, Roxanna LK, Sum CH, Lui DT, Cheung RT, Leung GK, Chan KH, Teo KC, Lau KK. Association of LDL-cholesterol <1.8 mmol/L and statin use with the recurrence of intracerebral hemorrhage. Int J Stroke 2024:17474930241239523. [PMID: 38429252 DOI: 10.1177/17474930241239523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
BACKGROUND Recent intensive low-density lipoprotein cholesterol (LDL-C) lowering trials, including FOURIER, ODYSSEY OUTCOMES, and Treat Stroke to Target (TST) trials, have mostly refuted the concern surrounding statin use, LDL-C lowering, and intracerebral hemorrhage (ICH) risk. However, the results from these trials may not be fully applied to ICH survivors, as the populations studied were mainly patients without prior ICH, in whom the inherent ICH risk is more than 10 times lower than that of ICH survivors. Although available literature on statin use after ICH has demonstrated no excess risk of recurrent ICH, other potential factors that may modify ICH risk, especially hypertension control and ICH etiology, have not generally been considered. Notably, data on LDL-C levels following ICH are lacking. AIMS We aim to investigate the association between LDL-C levels and statin use with ICH risk among ICH survivors, and to determine whether the risk differed with patients' characteristics, especially ICH etiology. METHODS Follow-up data of consecutive spontaneous ICH survivors enrolled in the University of Hong Kong prospective stroke registry from 2011 to 2019 were retrospectively analyzed. ICH etiology was classified as cerebral amyloid angiopathy (CAA) using the modified Boston criteria or hypertensive arteriopathy, while the mean follow-up LDL-C value was categorized as <1.8 or ⩾1.8 mmol/L. The primary endpoint was recurrent ICH. The association of LDL-C level and statin use with recurrent ICH was determined using multivariable Cox regression. Pre-specified subgroup analyses were performed, including based on ICH etiology and statin prescription. Follow-up blood pressure was included in all the regression models. RESULTS In 502 ICH survivors (mean age = 64.2 ± 13.5 years, mean follow-up LDL-C = 2.2 ± 0.6 mmol/L, 28% with LDL-C <1.8 mmol/L), 44 had ICH recurrence during a mean follow-up of 5.9 ± 2.8 years. Statin use after ICH was not associated with recurrent ICH (adjusted hazard ratio (AHR) = 1.07, 95% confidence interval (CI) = 0.57-2.00). The risk of ICH recurrence was increased for follow-up LDL-C <1.8 mmol/L (AHR = 1.99, 95% CI = 1.06-3.73). This association was predominantly observed in ICH attributable to CAA (AHR = 2.52, 95% CI = 1.06-5.99) and non-statin users (AHR = 2.91, 95% CI = 1.08-7.86). CONCLUSION The association between post-ICH LDL-C <1.8 mmol/L and recurrent ICH was predominantly observed in CAA patients and those with intrinsically low LDL-C (non-statin users). While statins can be safely prescribed in ICH survivors, LDL-C targets should be individualized and caution must be exercised in CAA patients.
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Affiliation(s)
- Tsz-Ching Lee
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - William Cy Leung
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Chun Ho
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Megan Wl Chiu
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Ian Yh Leung
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Yuen-Kwun Wong
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Liu Kc Roxanna
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Christopher Hf Sum
- Division of Neurosurgery, Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - David Tw Lui
- Division of Endocrinology & Metabolism, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Raymond Tf Cheung
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Gilberto Kk Leung
- Division of Neurosurgery, Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Koon-Ho Chan
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kay-Cheong Teo
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kui-Kai Lau
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
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Guntu R, Patel A, Movahed MR, Hashemzadeh M, Hashemzadeh M. Association Between Idiopathic Thrombocytopenic Purpura and Hemorrhagic and Nonhemorrhagic Stroke. Crit Pathw Cardiol 2024; 23:26-29. [PMID: 37625190 DOI: 10.1097/hpc.0000000000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
BACKGROUND Idiopathic thrombocytopenic purpura (ITP) is characterized by a low platelet count. This may lead to an increased risk of hemorrhagic stroke but a lower rate of nonhemorrhagic stroke. The goal of this study was to evaluate the association between ITP and both hemorrhagic and nonhemorrhagic strokes using a large database. METHODS We used the Nationwide Inpatient Sample (NIS) database to analyze the occurrence of hemorrhagic and nonhemorrhagic stroke in patients with and without a diagnosis of ITP from 2005 to 2014. RESULTS Univariate analysis revealed a higher incidence of hemorrhagic stroke in patients with ITP in the year studied. (for example, in 2005: OR, 1.75; 95% CI, 1.57-1.94; P < 0.001; 2014: OR, 2.19; 95% CI, 2.03-2.36; P < 0.001). After adjusting for age, gender, race, and hypertension, hemorrhagic stroke remained significantly associated with ITP (in 2005: OR, 1.85; 95% CI, 1.49-1.89; P < 0.001; 2014: OR, 2.01; 95% CI, 1.86-2.18; P < 0.001) for all the years studied. Nonhemorrhagic stroke occurred at a lower rate in patients with ITP in most years (2006: OR, 0.91; 95% CI, 0.85-0.97; P = 0.004; 2014: OR, 0.88; 95% CI, 0.83-0.93; P < 0.001). Multivariate analysis confirmed a higher rate of nonhemorrhagic stroke in ITP patients. CONCLUSION Our analysis showed that there was a higher rate of hemorrhagic stroke but a lower rate of ischemic stroke in ITP patients, suggesting an important role of platelets in the occurrence of stroke.
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Affiliation(s)
- Rachna Guntu
- From the University of Arizona, College of Medicine Phoenix, AZ
| | - Aamir Patel
- From the University of Arizona, College of Medicine Phoenix, AZ
| | - Mohammad Reza Movahed
- From the University of Arizona, College of Medicine Phoenix, AZ
- University of Arizona, Sarver Heart Center
| | | | - Mehrnoosh Hashemzadeh
- From the University of Arizona, College of Medicine Phoenix, AZ
- Pima Community College, Tucson, AZ
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Cao H, Morotti A, Mazzacane F, Desser D, Schlunk F, Güttler C, Kniep H, Penzkofer T, Fiehler J, Hanning U, Dell'Orco A, Nawabi J. External Validation and Retraining of DeepBleed: The First Open-Source 3D Deep Learning Network for the Segmentation of Spontaneous Intracerebral and Intraventricular Hemorrhage. J Clin Med 2023; 12:4005. [PMID: 37373699 DOI: 10.3390/jcm12124005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/03/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The objective of this study was to assess the performance of the first publicly available automated 3D segmentation for spontaneous intracerebral hemorrhage (ICH) based on a 3D neural network before and after retraining. METHODS We performed an independent validation of this model using a multicenter retrospective cohort. Performance metrics were evaluated using the dice score (DSC), sensitivity, and positive predictive values (PPV). We retrained the original model (OM) and assessed the performance via an external validation design. A multivariate linear regression model was used to identify independent variables associated with the model's performance. Agreements in volumetric measurements and segmentation were evaluated using Pearson's correlation coefficients (r) and intraclass correlation coefficients (ICC), respectively. With 1040 patients, the OM had a median DSC, sensitivity, and PPV of 0.84, 0.79, and 0.93, compared to thoseo f 0.83, 0.80, and 0.91 in the retrained model (RM). However, the median DSC for infratentorial ICH was relatively low and improved significantly after retraining, at p < 0.001. ICH volume and location were significantly associated with the DSC, at p < 0.05. The agreement between volumetric measurements (r > 0.90, p > 0.05) and segmentations (ICC ≥ 0.9, p < 0.001) was excellent. CONCLUSION The model demonstrated good generalization in an external validation cohort. Location-specific variances improved significantly after retraining. External validation and retraining are important steps to consider before applying deep learning models in new clinical settings.
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Affiliation(s)
- Haoyin Cao
- Department of Radiology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Andrea Morotti
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, 25123 Brescia, Italy
| | - Federico Mazzacane
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- U.C. Malattie Cerebrovascolari e Stroke Unit, IRCCS Fondazione Mondino, 27100 Pavia, Italy
| | - Dmitriy Desser
- Department of Neuroradiology, Charité School of Medicine and University Hospital Berlin, 10117 Berlin, Germany
| | - Frieder Schlunk
- Department of Neuroradiology, Charité School of Medicine and University Hospital Berlin, 10117 Berlin, Germany
| | - Christopher Güttler
- Department of Neuroradiology, Charité School of Medicine and University Hospital Berlin, 10117 Berlin, Germany
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, 10178 Berlin, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany
| | - Andrea Dell'Orco
- Department of Neuroradiology, Charité School of Medicine and University Hospital Berlin, 10117 Berlin, Germany
| | - Jawed Nawabi
- Department of Radiology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Neuroradiology, Charité School of Medicine and University Hospital Berlin, 10117 Berlin, Germany
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, 10178 Berlin, Germany
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Liu CH, Wu YL, Hsu CC, Lee TH. Early Antiplatelet Resumption and the Risks of Major Bleeding After Intracerebral Hemorrhage. Stroke 2023; 54:537-545. [PMID: 36621820 DOI: 10.1161/strokeaha.122.040500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/28/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The appropriate timing of resuming antithrombotic therapy after intracerebral hemorrhage (ICH) remains unclear. The aim of this study was to compare the risks of major bleeding between early and late antiplatelet resumption in ICH survivors. METHODS Between 2008 and 2017, ICH patients were available in the National Health Insurance Research Database. Patients with a medication possession ratio of antiplatelet treatment ≥50% before ICH and after antiplatelet resumption were screened. We excluded patients with atrial fibrillation, heart failure, under anticoagulant or hemodialysis treatment, and developed cerebrovascular events or died before antiplatelet resumption. Finally, 1584 eligible patients were divided into EARLY (≤30 days) and LATE groups (31-365 days after the index ICH) based on the timing of antiplatelet resumption. Patients were followed until the occurrence of a clinical outcome, end of 1-year follow-up, death, or until December 31, 2018. The primary outcome was recurrent ICH. The secondary outcomes included all-cause mortality, major hemorrhagic events, major occlusive vascular events, and ischemic stroke. Cox proportional hazard model after matching was used for comparison between the 2 groups. RESULTS Both the EARLY and LATE groups had a similar risk of 1-year recurrent ICH (EARLY versus LATE: 3.12% versus 3.27%; adjusted hazard ratio [AHR], 0.967 [95% CI, 0.522-1.791]) after matching. Both groups also had a similar risk of each secondary outcome at 1-year follow-up. Subgroup analyses disclosed early antiplatelet resumption in the patients without prior cerebrovascular disease were associated with lower risks of all-cause mortality (AHR, 0.199 [95% CI, 0.054-0.739]) and major hemorrhagic events (AHR, 0.090 [95% CI, 0.010-0.797]), while early antiplatelet resumption in the patients with chronic kidney disease were associated with a lower risk of ischemic stroke (AHR, 0.065 [95% CI, 0.012-0.364]). CONCLUSIONS Early resumption of antiplatelet was as safe as delayed antiplatelet resumption in ICH patients. Besides, those without prior cerebrovascular disease or with chronic kidney disease may benefit more from early antiplatelet resumption.
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Affiliation(s)
- Chi-Hung Liu
- Department of Neurology, Linkou Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan (C.-H.L., T.-H.L.)
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei (C.-H.L.)
| | - Yi-Ling Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan (Y.-L.W., C.-C. H.)
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan (Y.-L.W., C.-C. H.)
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, and Department of Health Services Administration, China Medical University, Taichung, Taiwan (C.-C. H.)
| | - Tsong-Hai Lee
- Department of Neurology, Linkou Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan (C.-H.L., T.-H.L.)
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Risk factors for stroke recurrence in patients with hemorrhagic stroke. Sci Rep 2022; 12:17151. [PMID: 36229641 PMCID: PMC9562220 DOI: 10.1038/s41598-022-22090-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 10/10/2022] [Indexed: 01/04/2023] Open
Abstract
The risk factors for recurrence of hemorrhagic or ischemic stroke in patients with intracranial hemorrhage (ICH) are inconclusive. This study was designed to investigate the risk factors for stroke recurrence and the impact of antiplatelet on stroke recurrence in patients with ICH. This population-based case-cohort study analyzed the data obtained from a randomized sample of 2 million subjects in the Taiwan National Health Insurance Research Database. The survival of patients with hemorrhagic stroke from January 1, 2000, to December 31, 2013, was included in the study. During the 5-year follow-up period, the recurrence rate of stroke was 13.1% (7.01% hemorrhagic stroke, and 6.12% ischemic stroke). The recurrence rate of stroke was 13.3% in the without antiplatelet group and 12.6% in the antiplatelet group. The risk factor for hemorrhagic stroke was hypertension (OR 1.87). The risk factors for ischemic stroke were age (OR 2.99), diabetes mellitus (OR 1.28), hypertension (OR 2.68), atrial fibrillation (OR 1.97), cardiovascular disease (OR 1.42), and ischemic stroke history (OR 1.68). Antiplatelet may decrease risk of hemorrhagic stroke (OR 0.53). The risk of stroke recurrence is high in patients with ICH. Hypertension is a risk factor for ischemic and hemorrhagic stroke recurrence. Antiplatelet therapy does not decrease risk of ischemic stroke recurrence but may reduce recurrence of hemorrhagic stroke.
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Wang X, Zhang Y, Chong W, Hai Y, Wang P, Deng H, You C, Fang F. Association of Rebleeding and Delayed Cerebral Ischemia with Long-term Mortality Among 1-year Survivors After Aneurysmal Subarachnoid Hemorrhage. Curr Neurovasc Res 2022; 19:282-292. [PMID: 35996234 DOI: 10.2174/1567202619666220822105510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE The potential impact of rebleeding and Delayed Cerebral Ischemia (DCI) on long-term survival in patients with aneurysmal subarachnoid hemorrhage (aSAH) remained unclear. This study aimed to investigate whether DCI and rebleeding increase the risk of long-term all-cause mortality in patients with aSAH who survived the follow-up period of one year. METHODS We retrospectively collected data on patients with atraumatic aSAH who were still alive 12 months after aSAH occurrence between December 2013 and June 2019 from the electronic health system. Patients were then classified by the occurrence of rebleeding or DCI during hospitalization. Death records were obtained from an administrative database, the Chinese Household Registration Administration System, until April 20, 2021. Multivariable Cox proportional hazards models were used to compare overall survival in different groups. Sensitivity analysis was performed with propensity-score matching (PSM). RESULTS A total of 2,607 patients were alive one year after aSAH. The crude annual death rate from any cause among patients who had rebleeding (7.2 per 100 person-years) and patients who had DCI (3.7 per 100 person-years) during hospitalization was higher than that of patients with neither event (2.1 per 100 person-years). Multivariate analysis showed that rebleeding is an independent risk factor for long-term mortality (adjusted hazard ratio (aHR), 2.37; 95% confidence interval (CI), 1.47- 3.81). DCI was an independent prognostic factor of poorer overall survival (aHR, 2.09; 95% CI, 1.54-2.84). CONCLUSION Amongst patients alive one year after aSAH, rebleeding and DCI during hospitalization were independently associated with higher rates of long-term mortality.
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Affiliation(s)
- Xing Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, 19144 USA
| | - Yang Hai
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, 19144 USA
| | - Peng Wang
- Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Haidong Deng
- Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Wu HH, Chang SH, Lee TH, Tu HT, Liu CH, Chang TY. Concurrent use of statins decreases major bleeding and intracerebral hemorrhage in non-valvular atrial fibrillation patients taking direct oral anticoagulants—A nationwide cohort study. Front Cardiovasc Med 2022; 9:969259. [PMID: 36003918 PMCID: PMC9393418 DOI: 10.3389/fcvm.2022.969259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background Statins are frequently prescribed with direct oral anticoagulants (DOACs), and previous studies have raised concerns about the increased risk of intracerebral hemorrhage or other major bleeding in concurrent statins and DOACs use. The objective of this study is to evaluate the risk of major bleeding in non-valvular atrial fibrillation patients taking DOACs with or without statins. Methods This nationwide, retrospective cohort study used data from the Taiwan National Health Insurance Research Database, enrolled a total of 90,731 non-valvular atrial fibrillation patients receiving rivaroxaban, dabigatran, apixaban or edoxaban from January 1st, 2012 to December 31st, 2017. Major bleeding was defined as a hospitalization or emergency department visit with a primary diagnosis of intracerebral hemorrhage, gastrointestinal tract bleeding, urogenital tract bleeding, or other sites of bleeding. Adjusted incidence rate ratios (IRR) and differences of major bleeding between person-quarters of DOACs with or without statins were estimated using a Poisson regression and inverse probability of treatment weighting using the propensity score. Results 50,854 (56.0%) of them were male with a mean age of 74.9 (SD, 10.4) years. Using DOACs without statins as a reference, the adjusted IRR for all major bleedings in concurrent use of DOACs and statins was 0.8 (95% CI 0.72–0.81). Lower major bleeding risk was seen in both low-to-moderate-intensity statins (IRR: 0.8, 95% CI 0.74–0.84) and high-intensity statins (IRR: 0.8, 95% CI 0.74–0.88). Concurrent use of DOACs and statins decreased the risk for intracerebral hemorrhage with an IRR of 0.8 (95% CI 0.66–0.93), and gastrointestinal tract bleeding with an IRR of 0.7 (95% CI 0.69–0.79). The protective effect of statins on intracerebral hemorrhage was observed only in female patients (IRR 0.67, 95% CI 0.51–0.89), but not in male patients (IRR 0.87, 95% CI 0.70–1.08). Conclusions Among non-valvular atrial fibrillation patients who were taking DOACs, concurrent use of statins decreased major bleeding risk, including intracerebral hemorrhage and gastrointestinal tract bleeding. Considering this and other cardioprotective effects, statins should be considered in all eligible patients prescribed with DOACs.
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Affiliation(s)
- Hsin-Hsu Wu
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shang-Hung Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Neurology, Stroke Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hui-Tzu Tu
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chi-Hung Liu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Neurology, Stroke Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ting-Yu Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Neurology, Stroke Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- *Correspondence: Ting-Yu Chang
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Jung NY, Cho J. Clinical effects of restarting antiplatelet therapy in patients with intracerebral hemorrhage. Clin Neurol Neurosurg 2022; 220:107361. [DOI: 10.1016/j.clineuro.2022.107361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/29/2022] [Accepted: 07/03/2022] [Indexed: 11/26/2022]
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9
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Peng TJ, Viscoli C, Khatri P, Wolfe SQ, Bhatt NR, Girotra T, Kamel H, Sheth KN. In Search of the Optimal Antithrombotic Regimen for Intracerebral Hemorrhage Survivors with Atrial Fibrillation. Drugs 2022; 82:965-977. [PMID: 35657478 DOI: 10.1007/s40265-022-01729-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 11/03/2022]
Abstract
Spontaneous intracerebral hemorrhage (ICH) constitutes 10-15% of all strokes, and is a significant cause of mortality and morbidity. Survivors of ICH, especially those with atrial fibrillation (AF), are at risk for both recurrent hemorrhagic and ischemic cerebrovascular events. A conundrum in the field of vascular neurology, neurosurgery, and cardiology has been the decision to initiate or resume versus withhold anticoagulation in survivors of ICH with AF. To initiate anticoagulation would decrease the risk of ischemic stroke but may increase the risk of hemorrhage. To withhold anticoagulation maintains a lower risk of hemorrhage but does not decrease the risk of ischemic stroke. In this narrative review, we discuss the evidence for and against the use of antithrombotics in ICH survivors with AF, focusing on recently completed and ongoing clinical trials.
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Affiliation(s)
- Teng J Peng
- Department of Neurology, Yale University School of Medicine, 15 York Street LCI, 1003C, New Haven, CT, 06510, USA
| | - Catherine Viscoli
- Department of Neurology, Yale University School of Medicine, 15 York Street LCI, 1003C, New Haven, CT, 06510, USA
| | - Pooja Khatri
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nirav R Bhatt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Tarun Girotra
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Kevin N Sheth
- Department of Neurology, Yale University School of Medicine, 15 York Street LCI, 1003C, New Haven, CT, 06510, USA.
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10
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Wan Y, Guo H, Bi R, Chen S, Shen J, Li M, Xia Y, Zhang L, Sun Z, Chen X, Cai Z, Wang Z, Gong D, Xu J, Zhu D, Hu B, He Q. Clinical and Prognostic Characteristics of Recurrent Intracerebral Hemorrhage: A Contrast to First-Ever ICH. Front Aging Neurosci 2022; 14:860571. [PMID: 35493945 PMCID: PMC9047504 DOI: 10.3389/fnagi.2022.860571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/28/2022] [Indexed: 11/18/2022] Open
Abstract
This study aimed to compare clinical and prognostic characteristics between recurrent and first-ever ICH. Four thousand twelve patients entered the study, and 64% of them were male. The median age is 62 years (interquartile range, 55–71). Among them, 3,750 (93.5%) patients had no experience of previous ICH, and 262 (6.5%) patients were considered as recurrent ICH. We compared demographic data, baseline clinical characteristics, imaging information, hematological parameters, and clinical outcomes between recurrent and first-ever ICH. We found that recurrent ICH was significantly associated with older age, more frequent history of ischemic heart disease, ischemic stroke, hypertension, and hyperlipidemia, while patients with recurrent ICH had previously received more antihypertensive therapy, and showed lower admission blood pressure (median, 160 vs. 167 mmHg) and higher baseline of National Institute of Health stroke scale (NIHSS) score (median, 10 vs. 9). We also demonstrated that recurrent ICH was an independent risk factor of 3-month function dependence after adjusting for many potentially competitive risk factors.
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Affiliation(s)
- Yan Wan
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongxiu Guo
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rentang Bi
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaoli Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Shen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Man Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanpeng Xia
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhou Sun
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolu Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuoyuan Cai
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhaowei Wang
- Department of Neurology, Qianjiang Central Hospital, Qianjiang, China
| | - Daokai Gong
- Department of Neurology, Jingzhou Central Hospital, Jingzhou, China
| | - Jingwen Xu
- Department of Neurology, Honghu People’s Hospital, Honghu, China
| | - Dongya Zhu
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Bo Hu,
| | - Quanwei He
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Quanwei He,
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11
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Gajurel BP, Nepal G, Kharel S, Yadav JK, Yadav SK, Shing YK, Goeschl S, Thapaliya S. Safety and efficacy of intravenous thrombolysis in acute ischemic stroke patients with a history of intracranial hemorrhage: A systematic review and meta-analysis. Clin Neurol Neurosurg 2022; 215:107205. [DOI: 10.1016/j.clineuro.2022.107205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/03/2022]
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12
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Murthy SB, Zhang C, Diaz I, Levitan EB, Koton S, Bartz TM, DeRosa JT, Strobino K, Colantonio LD, Iadecola C, Safford MM, Howard VJ, Longstreth WT, Gottesman RF, Sacco RL, Elkind MSV, Howard G, Kamel H. Association Between Intracerebral Hemorrhage and Subsequent Arterial Ischemic Events in Participants From 4 Population-Based Cohort Studies. JAMA Neurol 2021; 78:809-816. [PMID: 33938907 DOI: 10.1001/jamaneurol.2021.0925] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Intracerebral hemorrhage and arterial ischemic disease share risk factors, to our knowledge, but the association between the 2 conditions remains unknown. Objective To evaluate whether intracerebral hemorrhage was associated with an increased risk of incident ischemic stroke and myocardial infarction. Design, Setting, and Participants An analysis was conducted of pooled longitudinal participant-level data from 4 population-based cohort studies in the United States: the Atherosclerosis Risk in Communities (ARIC) study, the Cardiovascular Health Study (CHS), the Northern Manhattan Study (NOMAS), and the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Patients were enrolled from 1987 to 2007, and the last available follow-up was December 31, 2018. Data were analyzed from September 1, 2019, to March 31, 2020. Exposure Intracerebral hemorrhage, as assessed by an adjudication committee based on predefined clinical and radiologic criteria. Main Outcomes and Measures The primary outcome was an arterial ischemic event, defined as a composite of ischemic stroke or myocardial infarction, centrally adjudicated within each study. Secondary outcomes were ischemic stroke and myocardial infarction. Participants with prevalent intracerebral hemorrhage, ischemic stroke, or myocardial infarction at their baseline study visit were excluded. Cox proportional hazards regression was used to examine the association between intracerebral hemorrhage and subsequent arterial ischemic events after adjustment for baseline age, sex, race/ethnicity, vascular comorbidities, and antithrombotic medications. Results Of 55 131 participants, 47 866 (27 639 women [57.7%]; mean [SD] age, 62.2 [10.2] years) were eligible for analysis. During a median follow-up of 12.7 years (interquartile range, 7.7-19.5 years), there were 318 intracerebral hemorrhages and 7648 arterial ischemic events. The incidence of an arterial ischemic event was 3.6 events per 100 person-years (95% CI, 2.7-5.0 events per 100 person-years) after intracerebral hemorrhage vs 1.1 events per 100 person-years (95% CI, 1.1-1.2 events per 100 person-years) among those without intracerebral hemorrhage. In adjusted models, intracerebral hemorrhage was associated with arterial ischemic events (hazard ratio [HR], 2.3; 95% CI, 1.7-3.1), ischemic stroke (HR, 3.1; 95% CI, 2.1-4.5), and myocardial infarction (HR, 1.9; 95% CI, 1.2-2.9). In sensitivity analyses, intracerebral hemorrhage was associated with arterial ischemic events when updating covariates in a time-varying manner (HR, 2.2; 95% CI, 1.6-3.0); when using incidence density matching (odds ratio, 2.3; 95% CI, 1.3-4.2); when including participants with prevalent intracerebral hemorrhage, ischemic stroke, or myocardial infarction (HR, 2.2; 95% CI, 1.6-2.9); and when using death as a competing risk (subdistribution HR, 1.6; 95% CI, 1.1-2.1). Conclusions and Relevance This study found that intracerebral hemorrhage was associated with an increased risk of ischemic stroke and myocardial infarction. These findings suggest that intracerebral hemorrhage may be a novel risk marker for arterial ischemic events.
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Affiliation(s)
- Santosh B Murthy
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York, New York
| | - Cenai Zhang
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York, New York
| | - Ivan Diaz
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | - Silvia Koton
- School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.,The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle
| | - Janet T DeRosa
- Vagelos College of Physicians and Surgeons, Department of Neurology, Columbia University, New York, New York.,Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, New York
| | - Kevin Strobino
- Vagelos College of Physicians and Surgeons, Department of Neurology, Columbia University, New York, New York.,Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, New York
| | | | - Costantino Iadecola
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York, New York
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | - W T Longstreth
- Department of Neurology, University of Washington, Seattle.,Department of Epidemiology, University of Washington, Seattle
| | - Rebecca F Gottesman
- School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Mitchell S V Elkind
- Vagelos College of Physicians and Surgeons, Department of Neurology, Columbia University, New York, New York.,Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, New York
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York, New York.,Deputy Editor, JAMA Neurology
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13
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Jiang G, Cai H, Wen X, Chen K, Li H, Zhang Y, Yang Y, Chen J, Chen L. Cardiovascular and cerebrovascular events in patients with intracerebral hemorrhage: Clinical characteristics and long-term predictors. J Clin Neurosci 2021; 90:118-123. [PMID: 34275534 DOI: 10.1016/j.jocn.2021.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/11/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022]
Abstract
Few studies have examined the long-term prognosis of Chinese patients with intracerebral hemorrhage (ICH). This study assessed the clinical characteristics and predictors of vascular events occurring within 5 years after ICH. We included consecutive patients diagnosed with first-ever ICH between June 2013 and December 2014. Based on follow-up data (collected until December 2019), we used multivariable logistic regression to examine the clinical characteristics and long-term predictors of vascular events (including recurrent ICH, ischemic stroke, and acute coronary syndrome) in patients who survived more than 30 days after ICH. Across the 307 patients in our analysis, the 5-year mortality rate was 28.01%. Within 5 years after ICH, major vascular events were observed in 62 patients (17.82%, 95% CI 13.78-21.82%). We observed high incidence of recurrent ICH (8.91%) and ischemic stroke (10.06%), but low incidence of acute coronary syndrome (1.15%). Most cases of recurrent ICH (80.65%) occurred within 3 years after ICH. Age ≥56 years and history of ischemic stroke or transient ischemic attack (TIA) were identified as predictors of cardiovascular and cerebrovascular events. ICH survivors are at high risk of both cardiovascular and cerebrovascular events, especially older patients (≥56 years) and those who experienced ischemic stroke or TIA prior to their first ICH. Recurrent ICH is more likely to occur within the first three years after first ICH than at later times. Clinicians should monitor patients closely for adverse events, particularly during the first three years after initial ICH.
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Affiliation(s)
- Guimiao Jiang
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Hui Cai
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Xianlong Wen
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Kunfeng Chen
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Haicheng Li
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Yingdan Zhang
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Yue Yang
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Jiafeng Chen
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Li Chen
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China; Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
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14
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Li L, Poon MTC, Samarasekera NE, Perry LA, Moullaali TJ, Rodrigues MA, Loan JJM, Stephen J, Lerpiniere C, Tuna MA, Gutnikov SA, Kuker W, Silver LE, Al-Shahi Salman R, Rothwell PM. Risks of recurrent stroke and all serious vascular events after spontaneous intracerebral haemorrhage: pooled analyses of two population-based studies. Lancet Neurol 2021; 20:437-447. [PMID: 34022170 PMCID: PMC8134058 DOI: 10.1016/s1474-4422(21)00075-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 12/11/2020] [Accepted: 02/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with stroke due to spontaneous (non-traumatic) intracerebral haemorrhage (ICH) are at risk of recurrent ICH, ischaemic stroke, and other serious vascular events. We aimed to analyse these risks in population-based studies and compare them with the risks in RESTART, which assessed antiplatelet therapy after ICH. METHODS We pooled individual patient data from two prospective, population-based inception cohort studies of all patients with an incident firs-in-a-lifetime ICH in Oxfordshire, England (Oxford Vascular Study; April 1, 2002, to Sept 28, 2018) and Lothian, Scotland, UK (Lothian Audit of the Treatment of Cerebral Haemorrhage; June 1, 2010, to May 31, 2013). We quantified the absolute and relative risks of recurrent ICH, ischaemic stroke, or any serious vascular event (non-fatal stroke, non-fatal myocardial infarction, or vascular death), stratified by ICH location (lobar vs non-lobar) and comorbid atrial fibrillation (AF). We compared pooled event rates with those after allocation to avoid antiplatelet therapy in RESTART. FINDINGS Among 674 patients (mean age 74·7 years [SD 12·6], 320 [47%] men) with 1553 person-years of follow-up, 46 recurrent ICHs (event rate 3·2 per 100 patient-years, 95% CI 2·0-5·1) and 25 ischaemic strokes (1·7 per 100 patient-years, 0·8-3·3) were reported. Patients with lobar ICH (n=317) had higher risk of recurrent ICH (5·1 per 100 patient-years, 95% CI 3·6-7·2) than patients with non-lobar ICH (n=355; 1·8 per 100 patient-years, 1·0-3·3; hazard ratio [HR] 3·2, 95% CI 1·6-6·3; p=0·0010), but there was no evidence of a difference in the risk of ischaemic stroke (1·8 per 100 patient-years, 1·0-3·2, vs 1·6 per 100 patient-years, 0·6-4·4; HR 1·1, 95% CI 0·5-2·8). Conversely, there was no evidence of a difference in recurrent ICH rate in patients with AF (n=147; 3·3 per 100 patient-years, 95% CI 1·0-10·7) compared with those without (n=526; 3·2 per 100 patient-years, 2·2-4·7; HR 0·9, 95% CI 0·4-2·1), but the risk of ischaemic stroke was higher with AF (6·3 per 100 patient-years, 3·7-10·9, vs 0·7 per 100 patient-years, 0·1-5·6; HR 8·2, 3·3-20·3; p<0·0001), resulting in patients with AF having a higher risk of all serious vascular events than patients without AF (15·5 per 100 patient-years, 10·0-24·1, vs 6·8 per 100 patient-years, 3·6-12·5; HR 1·78, 95% CI 1·16-2·74; p=0·0090). Only for patients with lobar ICH without comorbid AF was the risk of recurrent ICH greater than the risk of ischaemic stroke (5·2 per 100 patient-years, 95% CI 3·6-7·5, vs 0·9 per 100 patient-years, 0·2-4·8; p=0·00034). Comparing data from the pooled population-based studies with that from patients allocated to not receive antiplatelet therapy in RESTART, there was no evidence of a difference in the rate of recurrent ICH (3·5 per 100 patient-years, 95% CI 1·9-6·0, vs 4·4 per 100 patient-years, 2·6-6·1) or ischaemic stroke (3·4 per 100 patient-years, 1·9-5·9, vs 5·3 per 100 patient-years, 3·3-7·2). INTERPRETATION The risks of recurrent ICH, ischaemic stroke, and all serious vascular events after ICH differ by ICH location and comorbid AF. These data enable risk stratification of patients in clinical practice and ongoing randomised trials. FUNDING UK Medical Research Council, Stroke Association, British Heart Foundation, Wellcome Trust, and the National Institute for Health Research Oxford Biomedical Research Centre.
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Affiliation(s)
- Linxin Li
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Michael T C Poon
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Luke A Perry
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Tom J Moullaali
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; The George Institute for Global Health, Sydney, NSW, Australia
| | - Mark A Rodrigues
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Department of Neuroradiology, NHS Lothian, Edinburgh, UK
| | - James J M Loan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | - Maria A Tuna
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sergei A Gutnikov
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Wilhelm Kuker
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Louise E Silver
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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15
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Yang J, Wang K, Liu Q, Mo S, Wu J, Yang S, Guo R, Yang Y, Zhang J, Liu Y, Cao Y, Wang S. A nomogram to predict the risk of early postoperative ischemic events in patients with spontaneous intracranial hematoma. Neurosurg Rev 2021; 44:3557-3566. [PMID: 33877464 DOI: 10.1007/s10143-021-01533-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/10/2021] [Accepted: 03/19/2021] [Indexed: 11/27/2022]
Abstract
Spontaneous intracranial hematoma (ICH) is the second leading cause of stroke and has a high risk of postoperative ischemic events (PIEs). But, the evidence on PIEs in ICH patients still lacks. Therefore, a retrospective study was carried out to screen the risk factors for PIEs and construct a visual predictive model. This was a retrospective study whose population were divided into two groups based on the occurrence of PIEs. Univariate logistic regression analysis was used to determine factors associated with PIEs. Multifactorial logistic regression analysis was used to screen risk factors and construct the early PIEs risk nomogram. In addition, impact of PIEs on patient prognosis and surgery related costs was assessed. Out of 122 ICH patients, 24 (19.7%) were diagnosed with PIEs. Coronary heart disease history, ischemic stroke history, regular shaped hematoma and platelet number were identified as risk factors for early PIEs. Early PIEs risk nomogram showed good calibration and discrimination of the data with concordance index of 0.846 (95% confidence interval, 0.747-0.945) which was confirmed to be 0.827 through bootstrapping validation. In addition, there was statistical difference in discharged Glasgow Coma Scale score (P = 0.046) and surgery related costs (p = 0.031) between PIEs group and nPIEs group. These results showed the early PIEs risk nomogram was accurate for prediction risks of PIEs and the occurrence of PIEs affects prognosis of patients, and increases surgery related costs.
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Affiliation(s)
- Junhua Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Kaiwen Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Qingyuan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Shaohua Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Jun Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Shuzhe Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Rui Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Jiaming Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Yang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, NO.119 Nansihuanxilu, Fengtai District, Beijing, 100160, People's Republic of China.
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China.
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16
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Kuohn LR, Leasure AC, Acosta JN, Vanent K, Murthy SB, Kamel H, Matouk CC, Sansing LH, Falcone GJ, Sheth KN. Cause of death in spontaneous intracerebral hemorrhage survivors: Multistate longitudinal study. Neurology 2020; 95:e2736-e2745. [PMID: 32917797 PMCID: PMC7734723 DOI: 10.1212/wnl.0000000000010736] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/18/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the leading causes of death in intracerebral hemorrhage (ICH) survivors, we used administrative data from 3 large US states to identify adult survivors of a first-time spontaneous ICH and track all hospital readmissions resulting in death. METHODS We performed a longitudinal analysis of prospectively collected claims data from hospitalizations in California (2005-2011), New York (2005-2014), and Florida (2005-2014). Adult residents admitted with a nontraumatic ICH who survived to discharge were included. Patients were followed for a primary outcome of any readmission resulting in death. The cause of death was defined as the primary diagnosis assigned at discharge. Multivariable Cox proportional hazards and multinomial logistic regression were used to determine factors associated with the risk for and cause of death. RESULTS Of 72,432 ICH survivors (mean age 68 years [SD 16], 48% female), 12,753 (18%) died during a median follow-up period of 4.0 years (interquartile range 2.3-6.3). The leading causes of death were infection (34%), recurrent intracranial hemorrhage (14%), cardiac disease (8%), respiratory failure (8%), and ischemic stroke (5%). Death in patients with atrial fibrillation (AF) was more likely to be caused by ischemic stroke (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.9-2.9, p < 0.001) and less likely to be caused by recurrent intracranial hemorrhage (OR 0.7, 95% CI 0.6-0.8, p < 0.001) compared to patients without AF. CONCLUSIONS Infection is the leading cause of death in all ICH survivors. Survivors with AF were at increased risk for death from ischemic stroke. These findings will help prioritize interventions aimed to improve long-term survival and recovery in ICH survivors.
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Affiliation(s)
- Lindsey R Kuohn
- From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Audrey C Leasure
- From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Julian N Acosta
- From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Kevin Vanent
- From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Santosh B Murthy
- From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Hooman Kamel
- From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Charles C Matouk
- From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Lauren H Sansing
- From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Guido J Falcone
- From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Kevin N Sheth
- From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY.
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17
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van Nieuwenhuizen KM, Vaartjes I, Verhoeven JI, Rinkel GJ, Kappelle LJ, Schreuder FH, Klijn CJ. Long-term prognosis after intracerebral haemorrhage. Eur Stroke J 2020; 5:336-344. [PMID: 33598551 PMCID: PMC7856590 DOI: 10.1177/2396987320953394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/29/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction The aim of this study was to determine the risk of recurrent intracerebral haemorrhage (ICH), ischaemic stroke, all stroke, any vascular event and all-cause mortality in 30-day survivors of ICH, according to age and sex. Patients and methods We linked national hospital discharge, population and cause of death registers to obtain a cohort of Dutch 30-day survivors of ICH from 1998 to 2010. We calculated cumulative incidences of recurrent ICH, ischaemic stroke, all stroke and composite vascular outcome, adjusted for competing risk of death and all-cause mortality. Additionally, we compared survival with the general population. Results We included 19,444 ICH-survivors (52% male; median age 72 years, interquartile range 61–79; 78,654 patient-years of follow-up). First-year cumulative incidence of recurrent ICH ranged from 1.5% (95% confidence interval 0.9–2.3; men 35–54 years) to 2.4% (2.0–2.9; women 75–94 years). Depending on age and sex, 10-year risk of recurrent ICH ranged from 3.7% (2.6–5.1; men 35–54 years) to 8.1% (6.9–9.4; women 55–74 years); ischaemic stroke 2.6% to 7.0%, of all stroke 9.9% to 26.2% and of any vascular event 15.0% to 40.4%. Ten-year mortality ranged from 16.7% (35–54 years) to 90.0% (75–94 years). Relative survival was lower in all age-groups of both sexes, ranging from 0.83 (0.80–0.87) in 35- to 54-year-old men to 0.28 (0.24–0.32) in 75- to 94-year-old women. Discussion ICH-survivors are at high risk of recurrent ICH, of ischaemic stroke and other vascular events, and have a sustained reduced survival rate compared to the general population. Conclusion The high risk of recurrent ICH, other vascular events and prolonged reduced survival-rates warrant clinical trials to determine optimal secondary prevention treatment after ICH.
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Affiliation(s)
- Koen M van Nieuwenhuizen
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jamie I Verhoeven
- Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gabriel Je Rinkel
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Floris Hbm Schreuder
- Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Catharina Jm Klijn
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
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18
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Qin H, Wang P, Zhang R, Yu M, Zhang G, Liu G, Wang Y. Stroke History is an Independent Risk Factor for Poor Prognosis in Ischemic Stroke Patients: Results from a Large Nationwide Stroke Registry. Curr Neurovasc Res 2020; 17:487-494. [PMID: 32807054 PMCID: PMC8493791 DOI: 10.2174/1567202617666200817141837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 11/27/2022]
Abstract
Background There is some controversy whether stroke history is an independent risk factor for poor prognosis
of stroke or not. This study aimed to investigate the difference of mortality, disability and recurrent rate of ischemic stroke
patients without and with stroke history, as well as to explore the effect of stroke history on stroke prognosis. Methods We analyzed patients with ischemic stroke enrolled in the China National Stroke Registry which was a nationwide,
multicenter, and prospective registry of consecutive patients with acute cerebrovascular events from 2007 to 2008.
Multivariable logistic regression was performed to assess the risk of worse prognosis of stroke history in patients with ischemic
stroke. Results A total of 8181(65.9%) patients without stroke history and 4234(34.1%) patients with stroke history were enrolled
in the study. The mortality, recurrence, modified Rankin Scale (mRS) 3-6 rate was 11.4%, 14.7% and 28.5% respectively
at 1 year for patients without stroke history, which was significantly lower than that of 17.3%, 23.6%, 42.1% in patients
with stroke history, respectively. Multivariable analysis showed that patients with stroke history had higher risk of death
[odds ratio (OR) 1.34,95% confidence interval (CI) 1.17-1.54], recurrence (OR 1.47, 95 % CI 1.31-1.65) and mRS 3-6 (OR
1.49,95% CI 1.34-1.66) at 1 year. Conclusion
After adjusting for the potential confounders, stroke history was still an independent risk factor for poor prognosis
of ischemic stroke, which further emphasizes the importance of secondary prevention of ischemic stroke. The specific
causes of poor prognosis in patients with history of stroke need to be furtherly investigated.
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Affiliation(s)
- Haiqiang Qin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Penglian Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Runhua Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Miaoxin Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guitao Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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19
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Casolla B, Cordonnier C. Intracerebral haemorrhage, microbleeds and antithrombotic drugs. Rev Neurol (Paris) 2020; 177:11-22. [PMID: 32747048 DOI: 10.1016/j.neurol.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/04/2020] [Accepted: 05/19/2020] [Indexed: 11/17/2022]
Abstract
Antithrombotic therapy is a cornerstone for secondary prevention of ischaemic events, cerebral and extra-cerebral. A number of clinical questions remain unanswered concerning the impact of antithrombotic drugs on the risk of first-ever and recurrent macro or micro cerebral haemorrhages, raising the clinical dilemma on the risk/benefit balance of giving antiplatelets and anticoagulants in patients with potential high risk of brain bleeds. High field magnetic resonance imaging (MRI) blood-weighted sequences, including susceptibility weighted imaging (SWI), have expanded the spectrum of these clinical questions, because of their increasing sensitivity in detecting radiological markers of small vessel disease. This review will summarise the literature, focusing on four main clinical questions: how do cerebral microbleeds impact the risk of cerebrovascular events in healthy patients, in patients with previous ischaemic stroke or transient ischaemic attack, and in patients with intracerebral haemorrhage? Is the risk/benefit balance of oral anticoagulants shifted by the presence of microbleeds in patients with atrial fibrillation after recent ischaemic stroke or transient ischaemic attack? Should we restart antiplatelet drugs after symptomatic intracerebral haemorrhage or not? Are oral anticoagulants allowed in patients with a history of atrial fibrillation and previous intracerebral haemorrhage?
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Affiliation(s)
- B Casolla
- University of Lille, Inserm, CHU of Lille, U1172-LilNCog-Lille Neuroscience & Cognition, 59000 Lille, France.
| | - C Cordonnier
- University of Lille, Inserm, CHU of Lille, U1172-LilNCog-Lille Neuroscience & Cognition, 59000 Lille, France
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20
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Li L, Luengo-Fernandez R, Zuurbier SM, Beddows NC, Lavallee P, Silver LE, Kuker W, Rothwell PM. Ten-year risks of recurrent stroke, disability, dementia and cost in relation to site of primary intracerebral haemorrhage: population-based study. J Neurol Neurosurg Psychiatry 2020; 91:580-585. [PMID: 32165376 PMCID: PMC7279204 DOI: 10.1136/jnnp-2019-322663] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/28/2020] [Accepted: 02/29/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patients with primary intracerebral haemorrhage (ICH) are at increased long-term risks of recurrent stroke and other comorbidities. However, available estimates come predominantly from hospital-based studies with relatively short follow-up. Moreover, there are also uncertainties about the influence of ICH location on risks of recurrent stroke, disability, dementia and quality of life. METHODS In a population-based study (Oxford Vascular Study/2002-2018) of patients with a first ICH with follow-up to 10 years, we determined the long-term risks of recurrent stroke, disability, quality of life, dementia and hospital care costs stratified by haematoma location. RESULTS Of 255 cases with primary ICH (mean/SD age 75.5/13.1), 109 (42.7%) had lobar ICH, 144 (56.5%) non-lobar ICH and 2 (0.8%) had uncertain location. Annual rates of recurrent ICH were higher after lobar versus non-lobar ICH (lobar=4.0%, 2.7-7.2 vs 1.1%, 0.3-2.8; p=0.02). Moreover, cumulative rate of dementia was also higher for lobar versus non-lobar ICH (n/% lobar=20/36.4% vs 16/20.8%, p=0.047), and there was a higher proportion of disability at 5 years in survivors (15/60.0% vs 9/31.0%, p=0.03). The 10-year quality-adjusted life years (QALYs) were also lower after lobar versus non-lobar ICH (2.9 vs 3.8 for non-lobar, p=0.04). Overall, the mean 10-year censor-adjusted costs were £19 292, with over 80% of costs due to inpatient hospital admission costs, which did not vary by haematoma location (p=0.90). CONCLUSION Compared with non-lobar ICH, the substantially higher 10-year risks of recurrent stroke, dementia and lower QALYs after lobar ICH highlight the need for more effective prevention for this patient group.
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Affiliation(s)
- Linxin Li
- Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, Oxfordshire, UK
| | - Ramon Luengo-Fernandez
- Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, Oxfordshire, UK
| | - Susanna M Zuurbier
- Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, Oxfordshire, UK
| | - Nicola C Beddows
- Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, Oxfordshire, UK
| | - Philippa Lavallee
- Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, Oxfordshire, UK
| | - Louise E Silver
- Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, Oxfordshire, UK
| | - Wilhelm Kuker
- Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, Oxfordshire, UK
| | - Peter Malcolm Rothwell
- Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, Oxfordshire, UK
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21
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Overvad TF, Andersen SD, Larsen TB, Lip GYH, Søgaard M, Skjøth F, Nielsen PB. Incidence and prognostic factors for recurrence of intracerebral hemorrhage in patients with and without atrial fibrillation: A cohort study. Thromb Res 2020; 191:1-8. [PMID: 32339765 DOI: 10.1016/j.thromres.2020.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intracerebral hemorrhage is a devastating vascular event. Clinical factors prognostic of recurrence facilitating individualized post-bleeding patient management are sparsely described. We aimed to describe incidence of recurrence of intracerebral hemorrhage and explore the prognostic value of 25 clinical characteristics in patients with and without atrial fibrillation. METHODS Cohort study of patients with incident intracerebral hemorrhage diagnosed from 2003 to 2016 identified using nationwide Danish administrative registries. Results reported as cumulative incidence of intracerebral recurrence accounting for competing risk of death. Univariate and multivariate prognostic factors for recurrence estimated using Cox regression (hazard ratios [HRs], 95% confidence intervals [CI]). RESULTS We identified 9255 patients with incident intracerebral hemorrhage (median age 73 years, 46.6% females, 16% with atrial fibrillation). Five-year risks of recurrence of intracerebral hemorrhage were approximately 10% in the study population, although slightly higher for patients without atrial fibrillation. Prognostic factors for recurrence were broadly similar for patients with and without atrial fibrillation. Age in categories <60 years (reference), age 60-70 years (HR 1.29, 95% CI 1.02-1.64), age 70-80 years (HR 1.59, 95% CI 1.26-2.00), age >80 years (HR 1.19, 95% CI 0.91-1.55), nursing home residency (HR 1.48, 95% CI 1.02-2.13), and Scandinavian Stroke Scale score ('mild' versus 'moderate' (HR 1.40, 95% CI 1.13-1.72) and 'severe' (HR 1.96, 95% CI 1.61-2.39)) were the strongest prognostic factors. CONCLUSION Risk of recurrence of intracerebral hemorrhage after five years was approximately 10%. Clinical characteristics associated with recurrence were few and broadly similar for patients with and without atrial fibrillation, with age and measure of incident bleeding severity, as reflected by Scandinavian Stroke Scale score, being the most important.
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Affiliation(s)
- Thure Filskov Overvad
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Internal Medicine, North Denmark Regional Hospital, Hjørring, Denmark.
| | - Søren Due Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - Torben Bjerregaard Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Mette Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Flemming Skjøth
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Unit for Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Brønnum Nielsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
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22
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Murthy SB, Wu X, Diaz I, Parasram M, Parikh NS, Iadecola C, Merkler AE, Falcone GJ, Brown S, Biffi A, Ch'ang J, Knopman J, Stieg PE, Navi BB, Sheth KN, Kamel H. Non-Traumatic Subdural Hemorrhage and Risk of Arterial Ischemic Events. Stroke 2020; 51:1464-1469. [PMID: 32178587 DOI: 10.1161/strokeaha.119.028510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background and Purpose- The risk of arterial ischemic events after subdural hemorrhage (SDH) is poorly understood. This study aimed to evaluate the risk of acute ischemic stroke and myocardial infarction among patients with and without nontraumatic SDH. Methods- We performed a retrospective cohort study using claims data from 2008 through 2014 from a nationally representative sample of Medicare beneficiaries. The exposure was nontraumatic SDH. Our primary outcome was an arterial ischemic event, a composite of acute ischemic stroke and acute myocardial infarction. Secondary outcomes were ischemic stroke alone and myocardial infarction alone. We used validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes to identify our predictor and outcomes. Using Cox regression and corresponding survival probabilities, adjusted for demographics and vascular comorbidities, we computed the hazard ratio in 4-week intervals after SDH discharge. We performed secondary analyses stratified by strong indications for antithrombotic therapy (composite of atrial fibrillation, peripheral vascular disease, valvular heart disease, and venous thromboembolism). Results- Among 1.7 million Medicare beneficiaries, 2939 were diagnosed with SDH. In the 4 weeks after SDH, patients' risk of an arterial ischemic event was substantially increased (hazard ratio, 3.6 [95% CI, 1.9-5.5]). There was no association between SDH diagnosis and arterial ischemic events beyond 4 weeks. In secondary analysis, during the 4 weeks after SDH, patients' risk of ischemic stroke was increased (hazard ratio, 4.2 [95% CI, 2.1-7.3]) but their risk of myocardial infarction was not (hazard ratio, 0.8 [95% CI, 0.2-1.7]). Patients with strong indications for antithrombotic therapy had increased risks for arterial ischemic events similar to patients in the primary analysis, but those without such indications did not demonstrate an increased risk for arterial ischemic events. Conclusions- Among Medicare beneficiaries, we found a heightened risk of arterial ischemic events driven by an increased risk of ischemic stroke, in the 4 weeks after nontraumatic SDH. This increased risk may be due to interruption of antithrombotic therapy after SDH diagnosis.
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Affiliation(s)
- Santosh B Murthy
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Xian Wu
- Department of Healthcare Policy and Research (X.W., I.D.), Weill Cornell Medicine, New York, NY
| | - Ivan Diaz
- Department of Healthcare Policy and Research (X.W., I.D.), Weill Cornell Medicine, New York, NY
| | - Melvin Parasram
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Neal S Parikh
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Costantino Iadecola
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Alexander E Merkler
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Guido J Falcone
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (G.J.F., S.B., K.N.S.)
| | - Stacy Brown
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (G.J.F., S.B., K.N.S.)
| | - Alessandro Biffi
- Center for Genomic Medicine (A.B.), Massachusetts General Hospital, Boston.,Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center (A.B.), Massachusetts General Hospital, Boston
| | - Judy Ch'ang
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Jared Knopman
- Department of Neurological Surgery (J.K., P.E.S.), Weill Cornell Medicine, New York, NY
| | - Philip E Stieg
- Department of Neurological Surgery (J.K., P.E.S.), Weill Cornell Medicine, New York, NY
| | - Babak B Navi
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (G.J.F., S.B., K.N.S.)
| | - Hooman Kamel
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
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23
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Murthy SB, Diaz I, Wu X, Merkler AE, Iadecola C, Safford MM, Sheth KN, Navi BB, Kamel H. Risk of Arterial Ischemic Events After Intracerebral Hemorrhage. Stroke 2020; 51:137-142. [PMID: 31771458 PMCID: PMC7001742 DOI: 10.1161/strokeaha.119.026207] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background and Purpose- The risk of arterial ischemic events after intracerebral hemorrhage (ICH) is poorly understood given the lack of a control group in prior studies. This study aimed to evaluate the risk of acute ischemic stroke and myocardial infarction (MI) among patients with and without ICH. Methods- We performed a retrospective cohort study using claims data from Medicare beneficiaries from 2008 to 2014. Our exposure was acute ICH, identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Our primary outcome was a composite of acute ischemic stroke and MI, whereas secondary outcomes were ischemic stroke alone and MI alone. We used Cox regression analysis to compute hazard ratios during 1-month intervals after ICH. Sensitivity analyses entailed exclusion of patients with atrial fibrillation and valvular heart disease. Results- Among 1 760 439 Medicare beneficiaries, 5924 had ICH. The 1-year cumulative incidence of an arterial ischemic event was 5.7% (95% CI, 4.8-6.8) in patients with ICH and 1.8% (95% CI, 1.7-1.9) in patients without ICH. After adjusting for potential confounders, the risk of an arterial ischemic event remained significantly increased for the first 6 months after ICH and was especially high in the first month (hazard ratio, 6.7 [95% CI, 5.0-8.6]). In secondary analysis, the risk of ischemic stroke was increased in the first 6 months after ICH (hazard ratio, 6.1 [95% CI, 3.5-9.3]) but the risk of MI was not (hazard ratio, 1.6 [95% CI, 0.3-2.9]). In sensitivity analyses excluding patients with atrial fibrillation and valvular heart disease, the association between ICH and arterial ischemic events was similar to that of the primary analysis. Conclusions- In a large population-based cohort, we found that elderly patients with ICH had a substantially increased risk of ischemic stroke in the first 6 months after diagnosis. Further exploration of this risk is needed to determine optimal secondary prevention strategies for these patients.
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Affiliation(s)
- Santosh B Murthy
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., I.D., X.W., A.E.M., C.I., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Ivan Diaz
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., I.D., X.W., A.E.M., C.I., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
- Department of Healthcare Policy and Research (I.D., X.W.), Weill Cornell Medicine, New York, NY
| | - Xian Wu
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., I.D., X.W., A.E.M., C.I., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
- Department of Healthcare Policy and Research (I.D., X.W.), Weill Cornell Medicine, New York, NY
| | - Alexander E Merkler
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., I.D., X.W., A.E.M., C.I., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Costantino Iadecola
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., I.D., X.W., A.E.M., C.I., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Monika M Safford
- Department of Internal Medicine (M.M.S.), Weill Cornell Medicine, New York, NY
| | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.)
| | - Babak B Navi
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., I.D., X.W., A.E.M., C.I., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
| | - Hooman Kamel
- From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., I.D., X.W., A.E.M., C.I., B.B.N., H.K.), Weill Cornell Medicine, New York, NY
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Leasure AC, King ZA, Torres-Lopez V, Murthy SB, Kamel H, Shoamanesh A, Al-Shahi Salman R, Rosand J, Ziai WC, Hanley DF, Woo D, Matouk CC, Sansing LH, Falcone GJ, Sheth KN. Racial/ethnic disparities in the risk of intracerebral hemorrhage recurrence. Neurology 2019; 94:e314-e322. [PMID: 31831597 DOI: 10.1212/wnl.0000000000008737] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 07/18/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To estimate the risk of intracerebral hemorrhage (ICH) recurrence in a large, diverse, US-based population and to identify racial/ethnic and socioeconomic subgroups at higher risk. METHODS We performed a longitudinal analysis of prospectively collected claims data from all hospitalizations in nonfederal California hospitals between 2005 and 2011. We used validated diagnosis codes to identify nontraumatic ICH and our primary outcome of recurrent ICH. California residents who survived to discharge were included. We used log-rank tests for unadjusted analyses of survival across racial/ethnic groups and multivariable Cox proportional hazards regression to determine factors associated with risk of recurrence after adjusting for potential confounders. RESULTS We identified 31,355 California residents with first-recorded ICH who survived to discharge, of whom 15,548 (50%) were white, 6,174 (20%) were Hispanic, 4,205 (14%) were Asian, and 2,772 (9%) were black. There were 1,330 recurrences (4.1%) over a median follow-up of 2.9 years (interquartile range 3.8). The 1-year recurrence rate was 3.0% (95% confidence interval [CI] 2.8%-3.2%). In multivariable analysis, black participants (hazard ratio [HR] 1.22; 95% CI 1.01-1.48; p = 0.04) and Asian participants (HR 1.29; 95% CI 1.10-1.50; p = 0.001) had a higher risk of recurrence than white participants. Private insurance was associated with a significant reduction in risk compared to patients with Medicare (HR 0.60; 95% CI 0.50-0.73; p < 0.001), with consistent estimates across racial/ethnic groups. CONCLUSIONS Black and Asian patients had a higher risk of ICH recurrence than white patients, whereas private insurance was associated with reduced risk compared to those with Medicare. Further research is needed to determine the drivers of these disparities.
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Affiliation(s)
- Audrey C Leasure
- From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH
| | - Zachary A King
- From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH
| | - Victor Torres-Lopez
- From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH
| | - Santosh B Murthy
- From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH
| | - Hooman Kamel
- From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH
| | - Ashkan Shoamanesh
- From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH
| | - Rustam Al-Shahi Salman
- From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH
| | - Jonathan Rosand
- From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH
| | - Wendy C Ziai
- From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH
| | - Daniel F Hanley
- From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH
| | - Daniel Woo
- From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH
| | - Charles C Matouk
- From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH
| | - Lauren H Sansing
- From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH
| | - Guido J Falcone
- From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH
| | - Kevin N Sheth
- From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH.
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Fam MD, Stadnik A, Zeineddine HA, Girard R, Mayo S, Dlugash R, McBee N, Lane K, Mould WA, Ziai W, Hanley D, Awad IA. Symptomatic Hemorrhagic Complications in Clot Lysis: Evaluation of Accelerated Resolution of Intraventricular Hemorrhage Phase III Clinical Trial (CLEAR III): A Posthoc Root-Cause Analysis. Neurosurgery 2019; 83:1260-1268. [PMID: 29294116 DOI: 10.1093/neuros/nyx587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 11/16/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As intraventricular thrombolysis for intraventricular hemorrhage (IVH) has developed over the last 2 decades, hemorrhagic complications have remained a concern despite general validation of its safety in controlled trials in the Clot Lysis: Evaluation of Accelerated Resolution of Intraventricular Hemorrhage Phase III (CLEAR-IVH) program. OBJECTIVE To analyze factors associated with symptomatic bleeding following IVH with and without thrombolysis in conjunction with the recently completed CLEAR III trial. METHODS We reviewed safety reports on symptomatic bleeding events reported during the first year after randomization among subjects enrolled in the CLEAR III trial. Clinical and imaging data were retrieved through the trial database as part of ongoing quality and safety monitoring. A posthoc root-cause analysis was performed to identify potential factors predisposing to rebleeding in each case. Cases were classified according to onset of rebleeding (during dosing, early after dosing and delayed), the pattern of bleeding, and treatment rendered (alteplase vs saline). RESULTS Twenty subjects developed a secondary symptomatic intracranial hemorrhage constituting 4% of subjects. Symptomatic rebleeding events occurred during the dosing protocol (n = 9, 67% alteplase), early after the protocol (n = 5, 40% alteplase), and late (n = 6, 0% alteplase). Catheter-related hemorrhages were the most common (n = 7, 35%) followed by expansion or new intraventricular (n = 6, 30%) and intracerebral (n = 5, 25%) hemorrhages. Symptomatic hemorrhages during therapy resulted from a combination of treatment- and patient-related factors and were at most partially attributable to alteplase. Rebleeding after the dosing protocol primarily reflected patients' risk factors. CONCLUSION Intraventricular thrombolysis marginally increases the overall risk of symptomatic hemorrhagic complications after IVH, and only during the treatment phase.
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Affiliation(s)
- Maged D Fam
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine, Chicago, Illinois
| | - Agnieszka Stadnik
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine, Chicago, Illinois
| | - Hussein A Zeineddine
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine, Chicago, Illinois
| | - Romuald Girard
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine, Chicago, Illinois
| | | | - Rachel Dlugash
- Brain Injury Outcomes Unit, Johns Hopkins University, Baltimore, Maryland
| | - Nichol McBee
- Brain Injury Outcomes Unit, Johns Hopkins University, Baltimore, Maryland
| | - Karen Lane
- Brain Injury Outcomes Unit, Johns Hopkins University, Baltimore, Maryland
| | - W Andrew Mould
- Brain Injury Outcomes Unit, Johns Hopkins University, Baltimore, Maryland
| | - Wendy Ziai
- Brain Injury Outcomes Unit, Johns Hopkins University, Baltimore, Maryland
| | - Daniel Hanley
- Brain Injury Outcomes Unit, Johns Hopkins University, Baltimore, Maryland
| | - Issam A Awad
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine, Chicago, Illinois
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26
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Das AS, Regenhardt RW, Feske SK, Gurol ME. Treatment Approaches to Lacunar Stroke. J Stroke Cerebrovasc Dis 2019; 28:2055-2078. [PMID: 31151838 PMCID: PMC7456600 DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/15/2019] [Accepted: 05/02/2019] [Indexed: 12/12/2022] Open
Abstract
Lacunar strokes are appropriately named for their ability to cavitate and form ponds or "little lakes" (Latin: lacune -ae meaning pond or pit is a diminutive form of lacus meaning lake). They account for a substantial proportion of both symptomatic and asymptomatic ischemic strokes. In recent years, there have been several advances in the management of large vessel occlusions. New therapies such as non-vitamin K antagonist oral anticoagulants and left atrial appendage closure have recently been developed to improve stroke prevention in atrial fibrillation; however, the treatment of small vessel disease-related strokes lags frustratingly behind. Since Fisher characterized the lacunar syndromes and associated infarcts in the late 1960s, there have been no therapies specifically targeting lacunar stroke. Unfortunately, many therapeutic agents used for the treatment of ischemic stroke in general offer only a modest benefit in reducing recurrent stroke while adding to the risk of intracerebral hemorrhage and systemic bleeding. Escalation of antithrombotic treatments beyond standard single antiplatelet agents has not been effective in long-term lacunar stroke prevention efforts, unequivocally increasing intracerebral hemorrhage risk without providing a significant benefit. In this review, we critically review the available treatments for lacunar stroke based on evidence from clinical trials. For several of the major drugs, we summarize the adverse effects in the context of this unique patient population. We also discuss the role of neuroprotective therapies and neural repair strategies as they may relate to recovery from lacunar stroke.
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Affiliation(s)
- Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Steven K Feske
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mahmut Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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27
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Moulin S, Cordonnier C. Role of Cerebral Microbleeds for Intracerebral Haemorrhage and Dementia. Curr Neurol Neurosci Rep 2019; 19:51. [PMID: 31218453 DOI: 10.1007/s11910-019-0969-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Cerebral microbleeds (CMB)-small round or ovoid lesions detected in hyposignal on blood-sensitive MRI sequences-are promising radiological biomarkers of cerebral small vessel disease. Their relations with ischaemic or haemorragic stroke and their potential contribution to dementia have been extensively addressed. This article reviews recent research on the clinical significance of CMB that remains to be determined. RECENT FINDINGS The presence, burden and location of CMB allow to obtain a more accurate estimate of intracerebral haemorrhage and ischaemic stroke risk. Most studies evaluating the association between CMB and dementia are hampered by methodological limitations and show conflicting results. CMB mainly reflect the severity of the underlying small vessel disease and should not be interpreted independently of the others neuroimaging biomarkers or the clinical setting. Future large prospective longitudinal studies and randomized controlled trials in various settings are required to determine whether specific therapies are beneficial in case of incidental findings.
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Affiliation(s)
- Solene Moulin
- Department of Neurology, Strasbourg University Hospital, Strasbourg, France.
| | - Charlotte Cordonnier
- Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, University of Lille, Lille, France
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28
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Pana TA, Wood AD, Perdomo-Lampignano JA, Tiamkao S, Clark AB, Kongbunkiat K, Bettencourt-Silva JH, Sawanyawisuth K, Kasemsap N, Mamas MA, Myint PK. Impact of heart failure on stroke mortality and recurrence. HEART ASIA 2019; 11:e011139. [PMID: 31244914 DOI: 10.1136/heartasia-2018-011139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 11/03/2022]
Abstract
Objective We aimed to examine the impact of heart failure (HF) on stroke mortality (in-hospital and postdischarge) and recurrence in a national stroke cohort from Thailand. Methods We used a large, insurance-based database including all stroke admissions in the public health sector in Thailand between 2004 and 2015. Logistic and Royston-Parmar regressions were used to quantify the effect of HF on in-hospital and long-term outcomes, respectively. All models were adjusted for age, sex and comorbidities and stratified by stroke type: acute ischaemic stroke (AIS) or intracerebral haemorrhage (ICH). Multistate models were constructed using flexible survival techniques to predict the impact of HF on the disease course of a patient with stroke (baseline-[recurrence]-death). Only first-ever cases of AIS or ICH were included in the multistate analysis. Results 608 890 patients (mean age 64.29±13.72 years, 55.07% men) were hospitalised (370 527 AIS, 173 236 ICH and 65 127 undetermined pathology). There were 398 663 patients with first-ever AIS and ICH. Patients were followed up for a median (95% CI) of 4.47 years (4.45 to 4.49). HF was associated with an increase in postdischarge mortality in AIS (HR [99% CI] 1.69 [1.64 to 1.74]) and ICH (2.59 [2.07 to 3.26]). HF was not associated with AIS recurrence, while ICH recurrence was only significantly increased within the first 3 years after discharge (1.79 [1.18 to 2.73]). Conclusions HF increases the risk of mortality in both AIS and ICH. We are the first to report on high-risk periods of stroke recurrence in patients with HF with ICH. Specific targeted risk reduction strategies may have significant clinical impact for mortality and recurrence in stroke.
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Affiliation(s)
- Tiberiu A Pana
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Adrian D Wood
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jesus A Perdomo-Lampignano
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Somsak Tiamkao
- Neurology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Kannikar Kongbunkiat
- Neurology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Ambulatory Medicine Division, Department of Meidicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Kittisak Sawanyawisuth
- Ambulatory Medicine Division, Department of Meidicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Narongrit Kasemsap
- North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand.,Ambulatory Medicine Division, Department of Meidicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Phyo K Myint
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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29
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Lee YM, Koo HW, Kang HK, Kim JW, Han SR, Yoon SW, Choi CY, Sohn MJ, Lee CH. The Prevalence and Characterization of Cerebral Microbleeds in Young People Having Intracerebral Hemorrhage. J Cerebrovasc Endovasc Neurosurg 2018; 20:112-119. [PMID: 30370245 PMCID: PMC6196144 DOI: 10.7461/jcen.2018.20.2.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/20/2018] [Accepted: 06/01/2018] [Indexed: 11/23/2022] Open
Abstract
Objective Cerebral microbleeds (CMBs) are known as the neuroimaging markers of risk in stroke and dementia. Many studies on CMBs in elderly patients with hemorrhagic or ischemic stroke have been reported; however, reports on CMBs in young populations with intracerebral hemorrhage (ICH) are lacking. Materials and Methods A total of 272 patients aged 18–54 years presented to our hospital with ICH between December 2009 and August 2017. Among these, CMB presence, count, and topography with respect to ICH were evaluated on magnetic resonance imaging (MRI) gradient echo images (GREs). We also evaluated the prevalence and risk factors of CMBs. Results Among 272 patients, only 66 underwent GRE T2-weighted MRI. CMBs were detected in 40 patients (61%), with 29 (73%) being of the multifocal type. Among the 219 CMBs, 150 (68.5%) were of the deep type and 69 (31.5%) of the lobar type. CMB prevalence was higher in men. In multivariate logistic regression analysis, history of hypertension (adjusted odds ratio [aOR], 4.048; 95% confidence interval [CI], 1.14–14.32; p = 0.030), and male sex (aOR, 4.233; 95% CI, 1.09–16.48; p = 0.037) were independently associated with CMBs. Conclusion In young patients who presented with spontaneous ICH, CMBs were highly prevalent in 61% of patients and strongly associated with history of hypertension and male sex.
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Affiliation(s)
- Young-Min Lee
- Department of Neurosurgery and Neuroscience Radiosurgery Adaptive Hybrid Neurosurgery Research Center, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hae-Won Koo
- Department of Neurosurgery and Neuroscience Radiosurgery Adaptive Hybrid Neurosurgery Research Center, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hyung Koo Kang
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jin Woo Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Seong Rok Han
- Department of Neurosurgery and Neuroscience Radiosurgery Adaptive Hybrid Neurosurgery Research Center, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sang Won Yoon
- Department of Neurosurgery and Neuroscience Radiosurgery Adaptive Hybrid Neurosurgery Research Center, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Chan Young Choi
- Department of Neurosurgery and Neuroscience Radiosurgery Adaptive Hybrid Neurosurgery Research Center, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Moon-Jun Sohn
- Department of Neurosurgery and Neuroscience Radiosurgery Adaptive Hybrid Neurosurgery Research Center, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Chae Heuck Lee
- Department of Neurosurgery and Neuroscience Radiosurgery Adaptive Hybrid Neurosurgery Research Center, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Sen S, Mitra K, Ganguli S, Mukherji S. I-gel™ May be the Device of Choice for Controlled Ventilation in Patients with Hemophilia Undergoing Abdominal Laparoscopic Surgery. Anesth Essays Res 2018; 12:288-290. [PMID: 29628601 PMCID: PMC5872885 DOI: 10.4103/0259-1162.172336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Haemophilia is an inherited bleeding disorder with variable deficiency of Factor VIII in the plasma and is characterised by bleeding into joints, muscles and tissues either spontaneously or in response to trivial trauma. Perioperative care requires multidisciplinary involvement. Perioperative management involves the risk of excessive bleeding from surgical site as well as spontaneous bleeding into the brain in response to surgical stress in patients with previous history of intracerebral haemorrhage. Airway management of such patients during anaesthetic intervention is a challenge and entails the risk of life threatening haemorrhage into the airway. The I gel Supraglottic airway device may be best suited for the purpose considering its soft elastomeric non-inflatable cuff, ease of insertion, availability of gastric suction port and minimal leak fraction on controlled ventilation. The I Gel may be solution to avoiding airway instrumentation in patients with bleeding disorders. It may be an alternative to endotracheal intubation in patients with Haemophilia undergoing surgery.
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Affiliation(s)
- Sreyashi Sen
- Department of Anaesthesiology, Medical College, Kolkata, West Bengal, India
| | - Koel Mitra
- Department of Anaesthesiology, Medical College, Kolkata, West Bengal, India
| | - Shanta Ganguli
- Department of Anaesthesiology, Medical College, Kolkata, West Bengal, India
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31
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Hankey GJ. Unanswered questions and research priorities to optimise stroke prevention in atrial fibrillation with the new oral anticoagulants. Thromb Haemost 2017; 111:808-16. [DOI: 10.1160/th13-09-0741] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 10/15/2013] [Indexed: 11/05/2022]
Abstract
SummaryThis review article discusses the following, as yet unanswered, questions and research priorities to optimise patient management and stroke prevention in atrial fibrillation with the new direct oral anticoagulants (NOACs): 1. In patients prescribed a NOAC, can the anticoagulant effects or plasma concentrations of the NOACs be measured rapidly and reliably and, if so, can “cut-off points” between which anticoagulation is therapeutic (i.e. the “therapeutic range”) be defined? 2. In patients who are taking a NOAC and bleeding (e.g. intracerebral haemorrhage), can the anticoagulant effects of the direct NOACs be reversed rapidly and, if so, can NOAC-associated bleeding and complications be minimised and patient outcome improved? 3. In patients taking a NOAC who experience an acute ischaemic stroke, to what degree of anticoagulation or plasma concentration of NOAC, if any, can thrombolysis be administered safely and effectively? 4. In patients with a recent cardioembolic ischaemic stroke, what is the optimal time to start (or re-start) anticoagulation with a NOAC (or warfarin)? 5. In anticoagulated patients who experience an intracranial haemorrhage, can anticoagulation with a NOAC be re-started safely and effectively, and if so when? 6. Are the NOACs effective and safe in multimorbid geriatric people (who commonly have atrial fibrillation and are at high risk of stroke but also bleeding)? 7. Can dose-adjusted NOAC therapy augment the established safety and efficacy of fixed-dose unmonitored NOAC therapy? 8. Is there a dose or dosing regimen for each NOAC that is as effective and safe as adjusted-dose warfarin for patients with atrial fibrillation who have mechanical prosthetic heart valves? 9. What is the long-term safety of the NOACs?
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Ding X, Liu X, Tan C, Yin M, Wang T, Liu Y, Mo L, Wei X, Tan X, Deng F, Chen L. Resumption of antiplatelet therapy in patients with primary intracranial hemorrhage-benefits and risks: A meta-analysis of cohort studies. J Neurol Sci 2017; 384:133-138. [PMID: 29153510 DOI: 10.1016/j.jns.2017.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/18/2017] [Accepted: 11/08/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Clinical disagreement over antiplatelet (AP) resumption in patients with primary intracranial hemorrhage (ICH) has long existed. This meta-analysis aimed to evaluate the benefits of AP resumption on preventing ischemic or thromboembolic events against its risks of promoting ICH recurrence or hematoma expansion. METHODS All relevant articles published in Pubmed, EMBASE, the Cochrane Library, and Science Direct from January 1950 to March 2017 were sourced, and the combined relative risk (RR) was calculated. RESULTS A total of 3648 articles were found, and after screening, 6 cohort studies including 1916 patients were included in this meta-analysis. AP resumption was associated with a decreased risk of ischemic or thromboembolic events (RR, 0.61; 95% confidence interval (CI), 0.48-0.79; P<0.01). There was no significant difference in the risk of ICH recurrence or hematoma expansion between patients with or without AP resumption (RR, 0.84; 95% CI, 0.47-1.51; P=0.56). CONCLUSION AP resumption in patients with primary ICH reduced the risk of ischemic or thromboembolic events, without significant increase of risk of ICH recurrence or hematoma expansion.
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Affiliation(s)
- Xueying Ding
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Xi Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Changhong Tan
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Maojia Yin
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Teng Wang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Ying Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Lijuan Mo
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Xin Wei
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Xinjie Tan
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Fen Deng
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
| | - Lifen Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
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Dang H, Stayman JW, Xu J, Zbijewski W, Sisniega A, Mow M, Wang X, Foos DH, Aygun N, Koliatsos VE, Siewerdsen JH. Task-based statistical image reconstruction for high-quality cone-beam CT. Phys Med Biol 2017; 62:8693-8719. [PMID: 28976368 DOI: 10.1088/1361-6560/aa90fd] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Task-based analysis of medical imaging performance underlies many ongoing efforts in the development of new imaging systems. In statistical image reconstruction, regularization is often formulated in terms to encourage smoothness and/or sharpness (e.g. a linear, quadratic, or Huber penalty) but without explicit formulation of the task. We propose an alternative regularization approach in which a spatially varying penalty is determined that maximizes task-based imaging performance at every location in a 3D image. We apply the method to model-based image reconstruction (MBIR-viz., penalized weighted least-squares, PWLS) in cone-beam CT (CBCT) of the head, focusing on the task of detecting a small, low-contrast intracranial hemorrhage (ICH), and we test the performance of the algorithm in the context of a recently developed CBCT prototype for point-of-care imaging of brain injury. Theoretical predictions of local spatial resolution and noise are computed via an optimization by which regularization (specifically, the quadratic penalty strength) is allowed to vary throughout the image to maximize local task-based detectability index ([Formula: see text]). Simulation studies and test-bench experiments were performed using an anthropomorphic head phantom. Three PWLS implementations were tested: conventional (constant) penalty; a certainty-based penalty derived to enforce constant point-spread function, PSF; and the task-based penalty derived to maximize local detectability at each location. Conventional (constant) regularization exhibited a fairly strong degree of spatial variation in [Formula: see text], and the certainty-based method achieved uniform PSF, but each exhibited a reduction in detectability compared to the task-based method, which improved detectability up to ~15%. The improvement was strongest in areas of high attenuation (skull base), where the conventional and certainty-based methods tended to over-smooth the data. The task-driven reconstruction method presents a promising regularization method in MBIR by explicitly incorporating task-based imaging performance as the objective. The results demonstrate improved ICH conspicuity and support the development of high-quality CBCT systems.
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Affiliation(s)
- Hao Dang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205, United States of America
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Biffi A, Kuramatsu JB, Leasure A, Kamel H, Kourkoulis C, Schwab K, Ayres AM, Elm J, Gurol ME, Greenberg SM, Viswanathan A, Anderson CD, Schwab S, Rosand J, Testai FD, Woo D, Huttner HB, Sheth KN. Oral Anticoagulation and Functional Outcome after Intracerebral Hemorrhage. Ann Neurol 2017; 82:755-765. [PMID: 29028130 DOI: 10.1002/ana.25079] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Oral anticoagulation treatment (OAT) resumption is a therapeutic dilemma in intracerebral hemorrhage (ICH) care, particularly for lobar hemorrhages related to amyloid angiopathy. We sought to determine whether OAT resumption after ICH is associated with long-term outcome, accounting for ICH location (ie, lobar vs nonlobar). METHODS We meta-analyzed individual patient data from: (1) the multicenter RETRACE study (n = 542), (2) a U.S.-based single-center ICH study (n = 261), and (3) the Ethnic/Racial Variations of Intracerebral Hemorrhage study (n = 209). We determined whether, within 1 year from ICH, OAT resumption was associated with: (1) mortality, (2) favorable functional outcome (modified Rankin Scale = 0-3), and (3) stroke incidence. We separately analyzed nonlobar and lobar ICH cases using propensity score matching and Cox regression models. RESULTS We included 1,012 OAT-related ICH survivors (633 nonlobar and 379 lobar). Among nonlobar ICH survivors, 178/633 (28%) resumed OAT, whereas 86/379 (23%) lobar ICH survivors did. In multivariate analyses, OAT resumption after nonlobar ICH was associated with decreased mortality (hazard ratio [HR] = 0.25, 95% confidence interval [CI] = 0.14-0.44, p < 0.0001) and improved functional outcome (HR = 4.22, 95% CI = 2.57-6.94, p < 0.0001). OAT resumption after lobar ICH was also associated with decreased mortality (HR = 0.29, 95% CI = 0.17-0.45, p < 0.0001) and favorable functional outcome (HR = 4.08, 95% CI = 2.48-6.72, p < 0.0001). Furthermore, OAT resumption was associated with decreased all-cause stroke incidence in both lobar and nonlobar ICH (both p < 0.01). INTERPRETATION These results suggest novel evidence of an association between OAT resumption and outcome following ICH, regardless of hematoma location. These findings support conducting randomized trials to explore risks and benefits of OAT resumption after ICH. Ann Neurol 2017;82:755-765.
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Affiliation(s)
- Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital, Boston, MA.,Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA.,Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA
| | - Joji B Kuramatsu
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Audrey Leasure
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Hooman Kamel
- Department of Neurology, Weill Cornell College of Medicine, New York, NY
| | - Christina Kourkoulis
- Department of Neurology, Massachusetts General Hospital, Boston, MA.,Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA.,Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA
| | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital, Boston, MA.,Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA
| | - Alison M Ayres
- Department of Neurology, Massachusetts General Hospital, Boston, MA.,Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA
| | - Jordan Elm
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Boston, MA.,Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Boston, MA.,Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Boston, MA.,Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA
| | - Christopher D Anderson
- Department of Neurology, Massachusetts General Hospital, Boston, MA.,Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA.,Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA
| | - Stefan Schwab
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Boston, MA.,Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA.,Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, IL
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH
| | - Hagen B Huttner
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Kevin N Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, CT
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Murthy SB, Moradiya Y, Shah J, Merkler AE, Mangat HS, Iadacola C, Hanley DF, Kamel H, Ziai WC. Nosocomial Infections and Outcomes after Intracerebral Hemorrhage: A Population-Based Study. Neurocrit Care 2017; 25:178-84. [PMID: 27350549 DOI: 10.1007/s12028-016-0282-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infections after intracerebral hemorrhage (ICH) may be associated with worse outcomes. We aimed to evaluate the association between nosocomial infections (>48 h) and outcomes of ICH at a population level. METHODS We identified patients with ICH using ICD-9-CM codes in the 2002-2011 Nationwide Inpatient Sample. Demographics, comorbidities, surgical procedures, and hospital characteristics were compared between patients with and without concomitant nosocomial infections. Primary outcomes were in-hospital mortality and home discharge. Secondary outcome was permanent cerebrospinal shunt placement. Logistic regression analyses were used to analyze the association between infections and outcomes. RESULTS Among 509,516 ICH patients, infections occurred in 117,636 (23.1 %). Rates of infections gradually increased from 18.7 % in 2002-2003 to 24.1 % in 2010-2011. Pneumonia was the most common nosocomial infection (15.4 %) followed by urinary tract infection (UTI) (7.9 %). Patients with infections were older (p < 0.001), predominantly female (56.9 % vs. 47.9 %, p < 0.001), and more often black (15.0 % vs. 13.4 %, p < 0.001). Nosocomial infection was associated with longer hospital stay (11 vs. 5 days, p < 0.001) and a more than twofold higher cost of care (p < 0.001). In the adjusted regression analysis, patients with infection had higher odds of mortality [odds ratio (OR) 2.11, 95 % CI 2.08-2.14] and cerebrospinal shunt placement (OR 2.19, 95 % CI 2.06-2.33) and lower odds of home discharge (OR 0.49, 95 % CI 0.47-0.51). Similar results were observed in subgroup analyses of individual infections. CONCLUSIONS In a nationally representative cohort of ICH patients, nosocomial infection was associated with worse outcomes and greater resource utilization.
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Affiliation(s)
- Santosh B Murthy
- Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY, 10065, USA. .,Clinical and Translational Neuroscience Unit, Feil Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA.
| | - Yogesh Moradiya
- Department of Neurosurgery, Northwell Long Island Jewish School of Medicine, New York, NY, USA
| | - Jharna Shah
- Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander E Merkler
- Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY, 10065, USA
| | - Halinder S Mangat
- Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY, 10065, USA
| | - Costantino Iadacola
- Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY, 10065, USA.,Clinical and Translational Neuroscience Unit, Feil Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA
| | - Daniel F Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hooman Kamel
- Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY, 10065, USA.,Clinical and Translational Neuroscience Unit, Feil Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA
| | - Wendy C Ziai
- Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lim YK, Shin DW, Kim HS, Yun JM, Shin JH, Lee H, Koo HY, Kim MJ, Yoon JY, Cho MH. Persistent smoking after a cardiovascular event: A nationwide retrospective study in Korea. PLoS One 2017; 12:e0186872. [PMID: 29049380 PMCID: PMC5648241 DOI: 10.1371/journal.pone.0186872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 10/09/2017] [Indexed: 11/19/2022] Open
Abstract
Smoking is a major risk factor of cardiovascular disease (CVD) such as stroke and ischemic heart disease. Prior studies have observed people continued smoking even after being diagnosed with CVD. However, population-level data regarding smoking behavior changes among people who are diagnosed with CVD are still lacking. From the National Health Insurance sample cohort database, we identified 1,700 patients diagnosed as having CVD between 2003 and 2012, and underwent the national health screening examination in the year before and after the CVD event. We found that 486 (28.6%) were smokers before the CVD event. Among them, 240 (49.4%) continued to smoke despite the diagnosis. We observed that a higher smoking amount and longer smoking duration before the diagnosis were associated with persistent smoking. Our finding that approximately 50% of smokers continue smoking even after CVD events supports the need for an assessment of patients' smoking statuses during follow-up after a CVD event and for health-care providers to offer the appropriate smoking cessation interventions to those who continue smoking.
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Affiliation(s)
- Yoo Kyoung Lim
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyeon Suk Kim
- School of Nursing, Shinhan University, Uijeongbu, Republic of Korea
| | - Jae Moon Yun
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Hyun Shin
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyejin Lee
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye Yeon Koo
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Yeon Yoon
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mi Hee Cho
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
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37
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Teo KC, Lau GK, Mak RH, Leung HY, Chang RS, Tse MY, Lee R, Leung GK, Ho SL, Cheung RT, Siu DC, Chan KH. Antiplatelet Resumption after Antiplatelet-Related Intracerebral Hemorrhage: A Retrospective Hospital-Based Study. World Neurosurg 2017; 106:85-91. [DOI: 10.1016/j.wneu.2017.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
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38
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Chung PW, Won YS. Cerebral Arterial Stenosis in Patients with Spontaneous Intracerebral Hemorrhage. J Korean Neurosurg Soc 2017; 60:511-517. [PMID: 28881113 PMCID: PMC5594619 DOI: 10.3340/jkns.2016.1011.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/06/2017] [Accepted: 04/11/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Spontaneous intracerebral hemorrhage (ICH) and ischemic stroke share common vascular risk factors such as aging and hypertension. Previous studies suggested that the rate of recurrent ICH and ischemic stroke might be similar after ICH. Presence of cerebral arterial stenosis is a potential risk factor for future ischemic stroke. This study investigated the prevalence and factors associated with cerebral arterial stenosis in Korean patients with spontaneous ICH. METHODS A total of 167 patients with spontaneous ICH were enrolled. Intracranial arterial stenosis (ICAS) and extracranial arterial stenosis (ECAS) were assessed by computed tomography angiography. Presence of ICAS was defined if patients had arterial stenosis in at least one intracranial artery. ECAS was assessed in the extracranial carotid artery. More than 50% luminal stenosis was defined as presence of stenosis. Prevalence and factors associated with presence of ICAS and cerebral arterial stenosis (presence of ICAS and/or ECAS) were investigated by multivariable logistic regression analysis. RESULTS Thirty-two (19.2%) patients had ICAS, 7.2% had ECAS, and 39 (23.4%) patients had any cerebral arterial stenosis. Frequency of ICAS and ECAS did not differ among ganglionic ICH, lobar ICH, and brainstem ICH. Age was higher in patients with ICAS (67.6±11.8 vs. 58.9±13.6 years p=0.004) and cerebral arterial stenosis (67.9±11.6 vs. 59.3±13.5 years, p<0.001) compared to those without stenosis. Patients with ICAS were older, more frequently had diabetes, had a higher serum glucose level, and had a lower hemoglobin level than those without ICAS. Patients with cerebral arterial stenosis were older, had diabetes and lower hemoglobin level, which was consistent with findings in patients with ICAS. However, patients with cerebral arterial stenosis showed higher prevalence of hypertension and decreased kidney function compared to those without cerebral arterial stenosis. Multivariable logistic regression analyses showed that aging and presence of diabetes independently predicted the presence of ICAS, and aging, diabetes, and hypertension were independently associated with presence of cerebral arterial stenosis. CONCLUSION 19.2% of patients with spontaneous ICH had ICAS, but the prevalence of ECAS was relatively lower (7.2%) compared with ICAS. Aging and diabetes were independent factors for the presence of ICAS, whereas aging, hypertension, and diabetes were factors for the cerebral arterial stenosis.
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Affiliation(s)
- Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yu Sam Won
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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39
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Charidimou A, Boulouis G, Gurol ME, Ayata C, Bacskai BJ, Frosch MP, Viswanathan A, Greenberg SM. Emerging concepts in sporadic cerebral amyloid angiopathy. Brain 2017; 140:1829-1850. [PMID: 28334869 DOI: 10.1093/brain/awx047] [Citation(s) in RCA: 296] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 01/17/2017] [Indexed: 12/27/2022] Open
Abstract
Sporadic cerebral amyloid angiopathy is a common, well-defined small vessel disease and a largely untreatable cause of intracerebral haemorrhage and contributor to age-related cognitive decline. The term 'cerebral amyloid angiopathy' now encompasses not only a specific cerebrovascular pathological finding, but also different clinical syndromes (both acute and progressive), brain parenchymal lesions seen on neuroimaging and a set of diagnostic criteria-the Boston criteria, which have resulted in increasingly detected disease during life. Over the past few years, it has become clear that, at the pathophysiological level, cerebral amyloid angiopathy appears to be in part a protein elimination failure angiopathy and that this dysfunction is a feed-forward process, which potentially leads to worsening vascular amyloid-β accumulation, activation of vascular injury pathways and impaired vascular physiology. From a clinical standpoint, cerebral amyloid angiopathy is characterized by individual focal lesions (microbleeds, cortical superficial siderosis, microinfarcts) and large-scale alterations (white matter hyperintensities, structural connectivity, cortical thickness), both cortical and subcortical. This review provides an interdisciplinary critical outlook on various emerging and changing concepts in the field, illustrating mechanisms associated with amyloid cerebrovascular pathology and neurological dysfunction.
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Gregoire Boulouis
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian J Bacskai
- Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA
| | - Matthew P Frosch
- Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA.,C.S. Kubik Laboratory for Neuropathology, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA.,Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA
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Charidimou A, Imaizumi T, Moulin S, Biffi A, Samarasekera N, Yakushiji Y, Peeters A, Vandermeeren Y, Laloux P, Baron JC, Hernandez-Guillamon M, Montaner J, Casolla B, Gregoire SM, Kang DW, Kim JS, Naka H, Smith EE, Viswanathan A, Jäger HR, Al-Shahi Salman R, Greenberg SM, Cordonnier C, Werring DJ. Brain hemorrhage recurrence, small vessel disease type, and cerebral microbleeds: A meta-analysis. Neurology 2017; 89:820-829. [PMID: 28747441 PMCID: PMC5580863 DOI: 10.1212/wnl.0000000000004259] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 05/24/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We evaluated recurrent intracerebral hemorrhage (ICH) risk in ICH survivors, stratified by the presence, distribution, and number of cerebral microbleeds (CMBs) on MRI (i.e., the presumed causal underlying small vessel disease and its severity). METHODS This was a meta-analysis of prospective cohorts following ICH, with blood-sensitive brain MRI soon after ICH. We estimated annualized recurrent symptomatic ICH rates for each study and compared pooled odds ratios (ORs) of recurrent ICH by CMB presence/absence and presumed etiology based on CMB distribution (strictly lobar CMBs related to probable or possible cerebral amyloid angiopathy [CAA] vs non-CAA) and burden (1, 2-4, 5-10, and >10 CMBs), using random effects models. RESULTS We pooled data from 10 studies including 1,306 patients: 325 with CAA-related and 981 CAA-unrelated ICH. The annual recurrent ICH risk was higher in CAA-related ICH vs CAA-unrelated ICH (7.4%, 95% confidence interval [CI] 3.2-12.6 vs 1.1%, 95% CI 0.5-1.7 per year, respectively; p = 0.01). In CAA-related ICH, multiple baseline CMBs (versus none) were associated with ICH recurrence during follow-up (range 1-3 years): OR 3.1 (95% CI 1.4-6.8; p = 0.006), 4.3 (95% CI 1.8-10.3; p = 0.001), and 3.4 (95% CI 1.4-8.3; p = 0.007) for 2-4, 5-10, and >10 CMBs, respectively. In CAA-unrelated ICH, only >10 CMBs (versus none) were associated with recurrent ICH (OR 5.6, 95% CI 2.1-15; p = 0.001). The presence of 1 CMB (versus none) was not associated with recurrent ICH in CAA-related or CAA-unrelated cohorts. CONCLUSIONS CMB burden and distribution on MRI identify subgroups of ICH survivors with higher ICH recurrence risk, which may help to predict ICH prognosis with relevance for clinical practice and treatment trials.
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Affiliation(s)
- Andreas Charidimou
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Toshio Imaizumi
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Solene Moulin
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Alexandro Biffi
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Neshika Samarasekera
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Yusuke Yakushiji
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Andre Peeters
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Yves Vandermeeren
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Patrice Laloux
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Jean-Claude Baron
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Mar Hernandez-Guillamon
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Joan Montaner
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Barbara Casolla
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Simone M Gregoire
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Dong-Wha Kang
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Jong S Kim
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - H Naka
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Eric E Smith
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Anand Viswanathan
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Hans R Jäger
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Rustam Al-Shahi Salman
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Steven M Greenberg
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - Charlotte Cordonnier
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada
| | - David J Werring
- From the Stroke Research Centre (A.C., Y.Y., S.M.G., H.R.J., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Hemorrhagic Stroke Research Program, Department of Neurology (A.C., A.B., E.E.S., A.V., S.M.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Degenerative & Vascular Cognitive Disorders (S.M., B.C., C.C.), Univ Lille, Inserm, CHU Lille, France; Centre for Clinical Brain Sciences (N.S., R.A.-S.S.), University of Edinburgh, UK; Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc; Department of Neurology (Y.V., P.L.), CHU Dinant Godinne, Université Catholique de Louvain; Institute of Neuroscience (Y.V., P.L.), Université Catholique de Louvain, Brussels, Belgium; Department of Clinical Neurosciences (J.-C.B.), University of Cambridge, Addenbrooke's Hospital, UK; UMR 894 INSERM-Université Paris 5 (J.-C.B.), Sorbonne Paris Cité, Paris, France; Department of Neurology (M.H.-G., J.M.), Hospital Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain; Department of Neurology (D.-W.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.N.), Hiroshima Prefectural Hospital, Japan; and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada.
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Murthy SB, Merkler AE, Omran SS, Gialdini G, Gusdon A, Hartley B, Roh D, Mangat HS, Iadecola C, Navi BB, Kamel H. Outcomes after intracerebral hemorrhage from arteriovenous malformations. Neurology 2017; 88:1882-1888. [PMID: 28424275 DOI: 10.1212/wnl.0000000000003935] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/11/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare outcomes after intracerebral hemorrhage (ICH) from cerebral arteriovenous malformation (AVM) rupture and other causes of ICH. METHODS We performed a retrospective population-based study using data from the Nationwide Inpatient Sample. We used standard diagnosis codes to identify ICH cases from 2002 to 2011. Our predictor variable was cerebral AVM. Our primary outcomes were inpatient mortality and home discharge. We used logistic regression to compare outcomes between patients with ICH with and without AVM while adjusting for demographics, comorbidities, and hospital characteristics. In a confirmatory analysis using a prospective cohort of patients hospitalized with ICH at our institution, we additionally adjusted for hematoma characteristics and the Glasgow Coma Scale score. RESULTS Among 619,167 ICH hospitalizations, the 4,485 patients (0.7%, 95% confidence interval [CI] 0.6-0.8) with an AVM were younger and had fewer medical comorbidities than patients without AVM. After adjustment for confounders, patients with AVM had lower odds of death (odds ratio [OR] 0.5, 95% CI 0.4-0.7) and higher odds of home discharge (OR 2.0, 95% CI 1.4-3.0) than patients without AVM. In a confirmatory analysis of 342 patients with ICH at our institution, the 34 patients (9.9%, 95% CI 7.2-13.6) with a ruptured AVM had higher odds of ambulatory independence at discharge (OR 4.4, 95% CI 1.4-13.1) compared to patients without AVM. CONCLUSIONS Patients with ICH due to ruptured AVM have more favorable outcomes than patients with ICH from other causes.
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Affiliation(s)
- Santosh B Murthy
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY.
| | - Alexander E Merkler
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - Setareh Salehi Omran
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - Gino Gialdini
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - Aaron Gusdon
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - Benjamin Hartley
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - David Roh
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - Halinder S Mangat
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - Costantino Iadecola
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - Babak B Navi
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
| | - Hooman Kamel
- From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY
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42
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Murthy SB, Gupta A, Merkler AE, Navi BB, Mandava P, Iadecola C, Sheth KN, Hanley DF, Ziai WC, Kamel H. Restarting Anticoagulant Therapy After Intracranial Hemorrhage: A Systematic Review and Meta-Analysis. Stroke 2017; 48:1594-1600. [PMID: 28416626 DOI: 10.1161/strokeaha.116.016327] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/27/2017] [Accepted: 03/13/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE The safety and efficacy of restarting anticoagulation therapy after intracranial hemorrhage (ICH) remain unclear. We performed a systematic review and meta-analysis to summarize the associations of anticoagulation resumption with the subsequent risk of ICH recurrence and thromboembolism. METHODS We searched published medical literature to identify cohort studies involving adults with anticoagulation-associated ICH. Our predictor variable was resumption of anticoagulation. Outcome measures were thromboembolic events (stroke and myocardial infarction) and recurrence of ICH. After assessing study heterogeneity and publication bias, we performed a meta-analysis using random-effects models to assess the strength of association between anticoagulation resumption and our outcomes. RESULTS Eight studies were eligible for inclusion in the meta-analysis, with 5306 ICH patients. Almost all studies evaluated anticoagulation with vitamin K antagonists. Reinitiation of anticoagulation was associated with a significantly lower risk of thromboembolic complications (pooled relative risk, 0.34; 95% confidence interval, 0.25-0.45; Q=5.12, P for heterogeneity=0.28). There was no evidence of increased risk of recurrent ICH after reinstatement of anticoagulation therapy, although there was significant heterogeneity among included studies (pooled relative risk, 1.01; 95% confidence interval, 0.58-1.77; Q=24.68, P for heterogeneity <0.001). No significant publication bias was detected in our analyses. CONCLUSIONS In observational studies, reinstitution of anticoagulation after ICH was associated with a lower risk of thromboembolic complications and a similar risk of ICH recurrence. Randomized clinical trials are needed to determine the true risk-benefit profile of anticoagulation resumption after ICH.
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Affiliation(s)
- Santosh B Murthy
- From the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.).
| | - Ajay Gupta
- From the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.)
| | - Alexander E Merkler
- From the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.)
| | - Babak B Navi
- From the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.)
| | - Pitchaiah Mandava
- From the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.)
| | - Costantino Iadecola
- From the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.)
| | - Kevin N Sheth
- From the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.)
| | - Daniel F Hanley
- From the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.)
| | - Wendy C Ziai
- From the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.)
| | - Hooman Kamel
- From the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.)
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Qiu L, Upadhyaya T, See AAQ, Ng YP, Kon Kam King N. Incidence of Recurrent Intracerebral Hemorrhages in a Multiethnic South Asian Population. J Stroke Cerebrovasc Dis 2017; 26:666-672. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/09/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022] Open
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Kong F, Zhou J, Zhou W, Guo Y, Li G, Yang L. Protective role of microRNA-126 in intracerebral hemorrhage. Mol Med Rep 2017; 15:1419-1425. [PMID: 28112373 DOI: 10.3892/mmr.2017.6134] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/01/2016] [Indexed: 11/05/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is a disease associated with high mortality and morbidity. MicroRNAs (miRNAs) are important regulators of translation and have been reported to be associated with the pathogenesis of numerous cerebrovascular diseases, including ICH. The present study explored the role of miRNA (miR)‑126 in ICH. Adult male Wistar rats were randomly assigned to ICH model and sham groups. ICH was induced by intracerebral injection of collagenase. The mRNA expression levels of miR‑126 in the two groups were determined. The miR‑126 lentivirus expression vector pWPXL‑miR‑126 or negative control vector was then constructed and delivered via intraparenchymal injection. Following transduction, behavioral testing (rotarod and limb placement tests), relative hemorrhagic lesion size, apoptotic cells and protein levels of vascular endothelial growth factor (VEGF)‑A and caspase‑3 were determined. The relative expression levels of miR‑126 were significantly decreased in the ICH group compared to the sham group (P=0.026). Overexpression of miR‑126 significantly improved the relative duration of stay on the rotarod at day 2 (P=0.029) and 3 (P=0.033), and statistically reduced the deficit score (P=0.036), the relative size of hemorrhagic lesion (P=0.019) and the number of apoptotic cortical neurons (P=0.024) compared with the sham group. Additionally, the protein levels of VEGF‑A were significantly elevated, however levels of caspase‑3 were downregulated by overexpression of miR‑126 compared with the negative control group. MiR‑126 therefore exhibits a protective role in ICH. Overexpression of miR‑126 protects against ICH, and may be involved in the process of angiogenesis and exhibit an anti-apoptotic effect.
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Affiliation(s)
- Fangen Kong
- Department of Neurosurgery, Fifth Affiliated Hospital of Sun Yat‑Sen University, Zhuhai, Guangdong 519000, P.R. China
| | - Jianhui Zhou
- Department of Clinical Laboratory, Fifth Affiliated Hospital of Sun Yat‑Sen University, Zhuhai, Guangdong 519000, P.R. China
| | - Wenying Zhou
- Department of Central Laboratory, Fifth Affiliated Hospital of Sun Yat‑Sen University, Zhuhai, Guangdong 519000, P.R. China
| | - Yuanqing Guo
- Department of Orthopaedics, Fifth Affiliated Hospital of Sun Yat‑Sen University, Zhuhai, Guangdong 519000, P.R. China
| | - Guowei Li
- Department of Orthopaedics, Fifth Affiliated Hospital of Sun Yat‑Sen University, Zhuhai, Guangdong 519000, P.R. China
| | - Lukun Yang
- Department of Anesthesiology, Fifth Affiliated Hospital of Sun Yat‑Sen University, Zhuhai, Guangdong 519000, P.R. China
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Li Z, Li Y, Xu F, Zhang X, Tian Q, Li L. Minimal invasive puncture and drainage versus endoscopic surgery for spontaneous intracerebral hemorrhage in basal ganglia. Neuropsychiatr Dis Treat 2017; 13:213-219. [PMID: 28182164 PMCID: PMC5279848 DOI: 10.2147/ndt.s120368] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Two prevalent therapies for the treatment of spontaneous intracerebral hemorrhage (ICH) in basal ganglia are, minimally invasive puncture and drainage (MIPD), and endoscopic surgery (ES). Because both surgical techniques are of a minimally invasive nature, they have attracted greater attention in recent years. However, evidence comparing the curative effect of MIPD and ES has been uncertain. The indication for MIPD or ES has been uncertain till now. In the present study, 112 patients with spontaneous ICH in basal ganglia who received MIPD or ES were reviewed retrospectively. Baseline parameters prior to the operation, evacuation rate (ER), perihematoma edema, postoperative complications, and rebleeding incidences were collected. Moreover, 1-year postictus, the long-term functional outcomes of patients with regard to hematoma volume (HV) or Glasgow Coma Scale (GCS) score were judged, respectively, by the case fatality, Glasgow Outcome Scale (GOS), Barthel Index (BI), and modified Rankin Scale (mRS). The ES group had a higher ER than the MIPD group on postoperative day 1. The MIPD group had fewer adverse outcomes, which included less perihematoma edema, anesthetic time, and blood loss, than the ES group. The functional outcomes represented by GOS, BI, and mRS were better in the MIPD group than in the ES group for patients with HV 30-60 mL or GCS score 9-14. These results indicate that ES is more effective in evacuating hematoma in basal ganglia, while MIPD is less invasive than ES. Patients with HV 30-60 mL or GCS score 9-14 may benefit more from the MIPD procedure than from ES.
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Affiliation(s)
- Zhihong Li
- Department of Neurosurgery, Tangdu Hospital
| | - Yuqian Li
- Department of Neurosurgery, Tangdu Hospital
| | | | - Xi Zhang
- Department of Biomedical Engineering
| | - Qiang Tian
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi Province, People's Republic of China
| | - Lihong Li
- Department of Neurosurgery, Tangdu Hospital
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Murthy SB, Shastri A, Merkler AE, Hanley DF, Ziai WC, Fink ME, Iadecola C, Kamel H, Navi BB. Intracerebral Hemorrhage Outcomes in Patients with Systemic Cancer. J Stroke Cerebrovasc Dis 2016; 25:2918-2924. [PMID: 27569708 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 08/05/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Single-center studies suggest that patients with cancer have similar outcomes after intracerebral hemorrhage (ICH) compared to patients without cancer. However, these studies were limited by small sample sizes and high rates of intratumoral hemorrhage. Our hypothesis was that systemic cancer patients without brain involvement fare worse after ICH than patients without cancer. METHODS We identified all patients diagnosed with spontaneous ICH from 2002 to 2011 in the Nationwide Inpatient Sample. Our predictor variable was systemic cancer. Our primary outcome was discharge disposition, dichotomized into favorable discharge (home/self-care or rehabilitation) or unfavorable discharge (nursing facility, hospice, or death). We used logistic regression to compare outcomes and performed secondary analyses by cancer subtype (i.e., nonmetastatic solid tumors, nonmetastatic hematologic tumors, and metastatic solid or hematologic tumors). RESULTS Among 597,046 identified ICH patients, 22,394 (3.8%) had systemic cancer. Stroke risk factors such as hypertension and diabetes were more common in patients without cancer, whereas anticoagulant use and higher Charlson comorbidity scores were more common among cancer patients. In multivariate logistic regression analysis adjusted for demographics, comorbidities, and hospital-level characteristics, patients with cancer had higher odds of death (OR 1.62, 95% CI 1.56-1.69) and lower odds of favorable discharge (OR .59, 95% CI .56-.63) than patients without cancer. Among cancer groups, patients with nonmetastatic hematologic tumors and those with metastatic disease fared the worst. CONCLUSIONS Patients with systemic cancer have higher mortality and less favorable discharge outcomes after ICH than patients without cancer. Cancer subtype may influence outcomes after ICH.
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Affiliation(s)
- Santosh B Murthy
- Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.
| | - Aditi Shastri
- Department of Hematology and Medical Oncology, Albert Einstein College of Medicine, Bronx, New York
| | | | - Daniel F Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wendy C Ziai
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew E Fink
- Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Costantino Iadecola
- Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York
| | - Babak B Navi
- Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York
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Wassef A, Butcher K. Novel oral anticoagulant management issues for the stroke clinician. Int J Stroke 2016; 11:759-67. [PMID: 27465882 DOI: 10.1177/1747493016660100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/15/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Four nonvitamin K antagonist oral anticoagulants (NOACs) are approved for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). AIMS In this review, we assemble available evidence for the best management of ischemic and hemorrhagic stroke patients in the context of NOAC use. SUMMARY OF REVIEW NOACs provide predictable anticoagulation with fixed dosages. The direct thrombin inhibitor dabigatran and direct factor Xa inhibitors apixaban, edoxaban, and rivaroxaban are all noninferior to warfarin for the prevention of ischemic stroke and systemic embolism and are associated with reduced incidence of intracranial hemorrhage. While these agents offer treatment options for NVAF patients, they also present challenges specific to the clinician managing cerebrovascular disease patients. CONCLUSIONS We summarize available evidence and current approaches to the initiation, dosing, monitoring and potential reversal of NOACs in stroke patients.
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Affiliation(s)
- Andrew Wassef
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ken Butcher
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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Bjerkreim AT, Thomassen L, Waje-Andreassen U, Selvik HA, Næss H. Hospital Readmission after Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2016; 25:157-62. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 08/31/2015] [Accepted: 09/10/2015] [Indexed: 10/22/2022] Open
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Qureshi AI, Chughtai M, Malik AA, Bezzina C, Suri MFK. Incidental Asymptomatic Intracerebral Hemorrhages and Risk of Subsequent Cardiovascular Events and Cognitive Decline in Elderly Persons. J Stroke Cerebrovasc Dis 2015; 24:1217-22. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 12/10/2014] [Accepted: 01/12/2015] [Indexed: 10/23/2022] Open
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Koivunen RJ, Tatlisumak T, Satopää J, Niemelä M, Putaala J. Intracerebral hemorrhage at young age: long-term prognosis. Eur J Neurol 2015; 22:1029-37. [PMID: 25850522 DOI: 10.1111/ene.12704] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 02/06/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Intracerebral hemorrhage (ICH) is a devastating disorder associated with dismal outcomes. The long-term mortality and functional outcome of ICH in young patients was studied - areas so far poorly investigated. METHODS A follow-up study was performed on a cohort of patients. Clinical and imaging data on ICH patients aged 16-49 were retrospectively obtained and linked with a nationwide cause-of-death register. The modified Rankin Scale (mRS) was evaluated for 30-day survivors at a visit 9.7 (7.0-12.0) years after ICH onset. Independent factors associated with mortality and unfavorable functional outcome (mRS 2-5) were sought by multivariate analysis. RESULTS Amongst the 268 1-month survivors, 1-year survival was 98.1% [95% confidence interval (CI) 96.2%-100%], 5-year survival 93.2% (89.3%-97.1%) and 10-year survival 88.8% (84.9%-92.7%). After adjustment for age and intraventricular hematoma extension, male sex [odds ratio (OR) 3.36, 95% CI 1.28-8.80] and diabetes (OR 2.64, 1.01-6.89) were associated with increased mortality. Unfavorable functional outcome emerged in 49%. After adjustment for confounders, age (OR 1.09 per 1 year, 95% CI 1.03-1.15), initial stroke severity (1.17 per one National Institutes of Health Stroke Scale score point, 1.08-1.27) and intraventricular hemorrhage (3.26, 1.11-9.55) were associated with unfavorable functional outcome. CONCLUSIONS Of every 10 survivors of acute phase ICH at a young age, one died within 10 years after onset, male sex and diabetes being associated with increased mortality. Half the survivors did not achieve a favorable functional outcome, which was predicted by increasing age, initial stroke severity and intraventricular hemorrhage.
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Affiliation(s)
- R-J Koivunen
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - T Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - J Satopää
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - M Niemelä
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - J Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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