Τίτλος:
Optimization of risk stratification for anticoagulation-associated intracerebral hemorrhage: net risk estimation
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Lioutas, V.-A.
Goyal, N.
Katsanos, A.H.
Krogias, C.
Zand, R.
Sharma, V.K.
Varelas, P.
Malhotra, K.
Paciaroni, M.
Karapanayiotides, T.
Sharaf, A.
Chang, J.
Kargiotis, O.
Pandhi, A.
Palaiodimou, L.
Schroeder, C.
Tsantes, A.
Boviatsis, E.
Mehta, C.
Serdari, A.
Vadikolias, K.
Mitsias, P.D.
Selim, M.H.
Alexandrov, A.V.
Tsivgoulis, G.
Περιοδικό:
Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Λέξεις-κλειδιά:
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
DOI:
10.1007/s00415-019-09678-2
