|Title||Risk of Ischemic Stroke after Intracranial Hemorrhage in Patients with Atrial Fibrillation.|
|Publication Type||Journal Article|
|Year of Publication||2015|
|Authors||Lerario MP, Gialdini G, Lapidus DM, Shaw MM, Navi BB, Merkler AE, Lip GYH, Healey JS, Kamel H|
|Keywords||Aged, Atrial Fibrillation, Brain Ischemia, Female, Humans, Intracranial Hemorrhages, Male, Prognosis, Retrospective Studies, Risk Factors, Stroke|
BACKGROUND: We aimed to estimate the risk of ischemic stroke after intracranial hemorrhage in patients with atrial fibrillation.
MATERIALS AND METHODS: Using discharge data from all nonfederal acute care hospitals and emergency departments in California, Florida, and New York from 2005 to 2012, we identified patients at the time of a first-recorded encounter with a diagnosis of atrial fibrillation. Ischemic stroke and intracranial hemorrhage were identified using validated diagnosis codes. Kaplan-Meier survival statistics and Cox proportional hazard analyses were used to evaluate cumulative rates of ischemic stroke and the relationship between incident intracranial hemorrhage and subsequent stroke.
RESULTS: Among 2,084,735 patients with atrial fibrillation, 50,468 (2.4%) developed intracranial hemorrhage and 89,594 (4.3%) developed ischemic stroke during a mean follow-up period of 3.2 years. The 1-year cumulative rate of stroke was 8.1% (95% CI, 7.5-8.7%) after intracerebral hemorrhage, 3.9% (95% CI, 3.5-4.3%) after subdural hemorrhage, and 2.0% (95% CI, 2.0-2.1%) in those without intracranial hemorrhage. After adjustment for the CHA2DS2-VASc score, stroke risk was elevated after both intracerebral hemorrhage (hazard ratio [HR], 2.8; 95% CI, 2.6-2.9) and subdural hemorrhage (HR, 1.6; 95% CI, 1.5-1.7). Cumulative 1-year rates of stroke ranged from 0.9% in those with subdural hemorrhage and a CHA2DS2-VASc score of 0, to 33.3% in those with intracerebral hemorrhage and a CHA2DS2-VASc score of 9.
CONCLUSIONS: In a large, heterogeneous cohort, patients with atrial fibrillation faced a substantially heightened risk of ischemic stroke after intracranial hemorrhage. The risk was most marked in those with intracerebral hemorrhage and high CHA2DS2-VASc scores.
|Alternate Journal||PLoS ONE|
|PubMed Central ID||PMC4689346|
|Grant List||K23 NS082367 / NS / NINDS NIH HHS / United States |
K23NS082367 / NS / NINDS NIH HHS / United States