Verhoeven JI, van Lith TJ, Ekker MS, Hilkens NA, Maaijwee NA, Rutten-Jacobs LCA, Klijn CJ, Leeuw FED. Long-term Risk of Bleeding and Ischemic Events After Ischemic Stroke or Transient Ischemic Attack in Young Adults.
Neurology 2022;
99:e549-e559. [PMID:
35654598 DOI:
10.1212/wnl.0000000000200808]
[Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/08/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES
Guidelines recommend antithrombotic medication as secondary prevention for patients with ischemic stroke or TIA at young age based on results from trials in older patients. We investigated the long-term risk of bleeding and ischemic events in young patients after ischemic stroke or TIA.
METHODS
We included 30-day survivors of first-ever ischemic stroke or TIA aged 18-50 years from the FUTURE study, a prospective cohort study of stroke at young age. We obtained information on recurrent ischemia based on structured data collection from 1995 until 2014 as part of the FUTURE study follow-up, complemented with information on any bleeding and ischemic events by retrospective chart review from baseline until last medical consultation or June 2020. Primary outcome was any bleeding, secondary outcome any ischemic event during follow-up. Both were stratified for sex, age, etiology, and use of antithrombotic medication at discharge. Bleeding and ischemic events were classified according to location and bleeding events also by severity.
RESULTS
We included 544 patients (56.1% women, median age of 42.2; interquartile range [IQR] 36.5-46.7 years) with a median follow-up of 9.6 (IQR 2.5-14.3) years. Ten-year cumulative risk of any bleeding event was 21.8% (95% confidence interval [CI] 17.4-26.0) and 33.9% (95% CI 28.3-37.5) of any ischemic event. Risk of bleeding was higher in women with a cumulative risk of 28.2% (95% CI 21.6-34.3) versus 13.7% (95% CI 8.2-18.9) in men (p<0.01), mainly due to gynecological bleeds. Female sex (p<0.001) and age between 40 and 49 years old (p=0.04) were independent predictors of bleeding.
DISCUSSION
Young patients after ischemic stroke or TIA have a substantial long-term risk of both bleeding (especially women) and ischemic events. Future studies should investigate the effects of long-term antithrombotics in young patients, taking into account the risk of bleeding complications.
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