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Non-Traumatic Subdural Hemorrhage and Risk of Arterial Ischemic Events.

TitleNon-Traumatic Subdural Hemorrhage and Risk of Arterial Ischemic Events.
Publication TypeJournal Article
Year of Publication2020
AuthorsMurthy SB, Wu X, Díaz 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
JournalStroke
Volume51
Issue5
Pagination1464-1469
Date Published2020 May
ISSN1524-4628
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 , , 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.

DOI10.1161/STROKEAHA.119.028510
Alternate JournalStroke
PubMed ID32178587
PubMed Central IDPMC7188584
Grant ListR01 NR018335 / NR / NINR NIH HHS / United States
U24 NS107136 / NS / NINDS NIH HHS / United States
R01 HL144541 / HL / NHLBI NIH HHS / United States
K23 NS091395 / NS / NINDS NIH HHS / United States
K76 AG059992 / AG / NIA NIH HHS / United States
P30 AG021342 / AG / NIA NIH HHS / United States
U24 NS107215 / NS / NINDS NIH HHS / United States
K23 NS100816 / NS / NINDS NIH HHS / United States
KL2 TR002385 / TR / NCATS NIH HHS / United States
R03 NS112859 / NS / NINDS NIH HHS / United States
R01 NS097443 / NS / NINDS NIH HHS / United States
U01 NS106513 / NS / NINDS NIH HHS / United States
K23 NS105948 / NS / NINDS NIH HHS / United States