TY - JOUR
TI - Optimization of risk stratification for anticoagulation-associated intracerebral hemorrhage: net risk estimation
AU - Lioutas, V.-A.
AU - Goyal, N.
AU - Katsanos, A.H.
AU - Krogias, C.
AU - Zand, R.
AU - Sharma, V.K.
AU - Varelas, P.
AU - Malhotra, K.
AU - Paciaroni, M.
AU - Karapanayiotides, T.
AU - Sharaf, A.
AU - Chang, J.
AU - Kargiotis, O.
AU - Pandhi, A.
AU - Palaiodimou, L.
AU - Schroeder, C.
AU - Tsantes, A.
AU - Boviatsis, E.
AU - Mehta, C.
AU - Serdari, A.
AU - Vadikolias, K.
AU - Mitsias, P.D.
AU - Selim, M.H.
AU - Alexandrov, A.V.
AU - Tsivgoulis, G.
JO - Egyptian Journal of Neurology, Psychiatry and Neurosurgery
PY - 2020
VL - 267
TODO - 4
SP - 1053-1062
PB - Springer-Verlag
SN - null
TODO - 10.1007/s00415-019-09678-2
TODO - anticoagulant agent;  antivitamin K;  creatinine;  hydroxymethylglutaryl coenzyme A reductase inhibitor;  anticoagulant agent, aged;  anticoagulation;  Article;  brain hemorrhage;  brain ischemia;  cardiovascular risk;  CHA2DS2-VASc score;  chronic kidney failure;  clinical assessment;  cohort analysis;  controlled study;  disease association;  female;  HAS BLED score;  high risk behavior;  human;  hypertension;  major clinical study;  male;  multicenter study;  prevalence;  priority journal;  process optimization;  prospective study;  risk assessment;  risk factor;  treatment indication;  brain hemorrhage;  brain ischemia;  severity of illness index;  very elderly, Aged;  Aged, 80 and over;  Anticoagulants;  Cerebral Hemorrhage;  Cohort Studies;  Female;  Humans;  Ischemic Stroke;  Male;  Risk Assessment;  Severity of Illness Index
TODO - Background: Every anticoagulation decision has in inherent risk of hemorrhage; intracerebral hemorrhage (ICH) is the most devastating hemorrhagic complication. We examined whether combining ischemic and hemorrhagic stroke risk in individual patients might provide a meaningful paradigm for risk stratification. Methods: We enrolled consecutive patients with anticoagulation-associated ICH in 15 tertiary centers in the USA, Europe and Asia between 2015 and 2017. Each patient was assigned baseline ischemic stroke and hemorrhage risk based on their CHA2DS2-VASc and HAS-BLED scores. We computed a net risk by subtracting hemorrhagic from ischemic risk. If the sum was positive the patient was assigned a “Favorable” indication for anticoagulation; if negative, “Unfavorable”. Results: We enrolled 357 patients [59% men, median age 76 (68–82) years]. 31% used non-vitamin K antagonist (NOAC). 191 (53.5%) patients had a favorable indication for anticoagulation prior to their ICH; 166 (46.5%) unfavorable. Those with unfavorable indication were younger [72 (66–80) vs 78 (73–84) years, p = 0.001], with lower CHA2DS2-VASc score [3(3–4) vs 5(4–6), p < 0.001]. Those with favorable indication had a significantly higher prevalence of most cardiovascular risk factors and were more likely to use a NOAC (35% vs 25%, p = 0.045). Both groups had similar prevalence of hypertension and chronic kidney disease. Conclusions: In this anticoagulation-associated ICH cohort, baseline hemorrhagic risk exceeded ischemic risk in approximately 50%, highlighting the importance of careful consideration of risk/benefit ratio prior to anticoagulation decisions. The remaining 50% suffered an ICH despite excess baseline ischemic risk, stressing the need for biomarkers to allow more precise estimation of hemorrhagic complication risk. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
ER -