Pfizer COVID-19 vaccine appointments are available to our patients. Sign up for Connect today to schedule your vaccination. Continue your routine care with us by scheduling an in-person appointment or Video Visit.

Risk of Arterial Ischemic Events After Intracerebral Hemorrhage.

TitleRisk of Arterial Ischemic Events After Intracerebral Hemorrhage.
Publication TypeJournal Article
Year of Publication2020
AuthorsMurthy SB, Diaz I, Wu X, Merkler AE, Iadecola C, Safford MM, Sheth KN, Navi BB, Kamel H
JournalStroke
Volume51
Issue1
Pagination137-142
Date Published2020 01
ISSN1524-4628
KeywordsAged, Aged, 80 and over, Anticoagulants, Atrial Fibrillation, Brain Ischemia, Cerebral Hemorrhage, Female, Humans, Male, Myocardial Infarction, Stroke, United States, Warfarin
Abstract

Background and Purpose- The risk of arterial ischemic events after intracerebral hemorrhage (ICH) is poorly understood given the lack of a control group in prior studies. This study aimed to evaluate the risk of acute ischemic stroke and myocardial infarction (MI) among patients with and without ICH. Methods- We performed a retrospective cohort study using claims data from Medicare beneficiaries from 2008 to 2014. Our exposure was acute ICH, identified using validated diagnosis codes. Our primary outcome was a composite of acute ischemic stroke and MI, whereas secondary outcomes were ischemic stroke alone and MI alone. We used Cox regression analysis to compute hazard ratios during 1-month intervals after ICH. Sensitivity analyses entailed exclusion of patients with atrial fibrillation and valvular heart disease. Results- Among 1 760 439 Medicare beneficiaries, 5924 had ICH. The 1-year cumulative incidence of an arterial ischemic event was 5.7% (95% CI, 4.8-6.8) in patients with ICH and 1.8% (95% CI, 1.7-1.9) in patients without ICH. After adjusting for potential confounders, the risk of an arterial ischemic event remained significantly increased for the first 6 months after ICH and was especially high in the first month (hazard ratio, 6.7 [95% CI, 5.0-8.6]). In secondary analysis, the risk of ischemic stroke was increased in the first 6 months after ICH (hazard ratio, 6.1 [95% CI, 3.5-9.3]) but the risk of MI was not (hazard ratio, 1.6 [95% CI, 0.3-2.9]). In sensitivity analyses excluding patients with atrial fibrillation and valvular heart disease, the association between ICH and arterial ischemic events was similar to that of the primary analysis. Conclusions- In a large population-based cohort, we found that elderly patients with ICH had a substantially increased risk of ischemic stroke in the first 6 months after diagnosis. Further exploration of this risk is needed to determine optimal secondary prevention strategies for these patients.

DOI10.1161/STROKEAHA.119.026207
Alternate JournalStroke
PubMed ID31771458
PubMed Central IDPMC7001742
Grant ListR01 NR018335 / NR / NINR NIH HHS / United States
U24 NS107136 / NS / NINDS NIH HHS / United States
UL1 TR001863 / TR / NCATS NIH HHS / United States
K23 NS091395 / NS / NINDS NIH HHS / United States
R01 NS097443 / NS / NINDS NIH HHS / United States
U24 NS107215 / NS / NINDS NIH HHS / United States
KL2 TR002385 / TR / NCATS NIH HHS / United States
U01 NS095869 / NS / NINDS NIH HHS / United States
U01 NS106513 / NS / NINDS NIH HHS / United States
K23 NS105948 / NS / NINDS NIH HHS / United States

Weill Cornell Medicine Neurology 525 E. 68th St.
PO Box 117
New York, NY 10065 Phone: (212) 746-6575