Optimization of risk stratification for anticoagulation-associated intracerebral hemorrhage : net risk estimation
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.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2020 |
|---|---|
| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:267 |
|---|---|
| Enthalten in: |
Journal of neurology - 267(2020), 4 vom: 17. Apr., Seite 1053-1062 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Lioutas, Vasileios-Arsenios [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Anticoagulants |
|---|
| Anmerkungen: |
Date Completed 01.01.2021 Date Revised 10.01.2021 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1007/s00415-019-09678-2 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM304495484 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM304495484 | ||
| 003 | DE-627 | ||
| 005 | 20231225115116.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2020 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1007/s00415-019-09678-2 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1014.xml |
| 035 | |a (DE-627)NLM304495484 | ||
| 035 | |a (NLM)31848737 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Lioutas, Vasileios-Arsenios |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Optimization of risk stratification for anticoagulation-associated intracerebral hemorrhage |b net risk estimation |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 01.01.2021 | ||
| 500 | |a Date Revised 10.01.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a 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" | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Anticoagulants | |
| 650 | 4 | |a Atrial fibrillation | |
| 650 | 4 | |a Intracerebral hemorrhage | |
| 650 | 4 | |a Risk assessment | |
| 650 | 7 | |a Anticoagulants |2 NLM | |
| 700 | 1 | |a Goyal, Nitin |e verfasserin |4 aut | |
| 700 | 1 | |a Katsanos, Aristeidis H |e verfasserin |4 aut | |
| 700 | 1 | |a Krogias, Christos |e verfasserin |4 aut | |
| 700 | 1 | |a Zand, Ramin |e verfasserin |4 aut | |
| 700 | 1 | |a Sharma, Vijay K |e verfasserin |4 aut | |
| 700 | 1 | |a Varelas, Panayiotis |e verfasserin |4 aut | |
| 700 | 1 | |a Malhotra, Konark |e verfasserin |4 aut | |
| 700 | 1 | |a Paciaroni, Maurizio |e verfasserin |4 aut | |
| 700 | 1 | |a Karapanayiotides, Theodore |e verfasserin |4 aut | |
| 700 | 1 | |a Sharaf, Aboubakar |e verfasserin |4 aut | |
| 700 | 1 | |a Chang, Jason |e verfasserin |4 aut | |
| 700 | 1 | |a Kargiotis, Odysseas |e verfasserin |4 aut | |
| 700 | 1 | |a Pandhi, Abhi |e verfasserin |4 aut | |
| 700 | 1 | |a Palaiodimou, Lina |e verfasserin |4 aut | |
| 700 | 1 | |a Schroeder, Christoph |e verfasserin |4 aut | |
| 700 | 1 | |a Tsantes, Argyrios |e verfasserin |4 aut | |
| 700 | 1 | |a Boviatsis, Efstathios |e verfasserin |4 aut | |
| 700 | 1 | |a Mehta, Chandan |e verfasserin |4 aut | |
| 700 | 1 | |a Serdari, Aspasia |e verfasserin |4 aut | |
| 700 | 1 | |a Vadikolias, Konstantinos |e verfasserin |4 aut | |
| 700 | 1 | |a Mitsias, Panayiotis D |e verfasserin |4 aut | |
| 700 | 1 | |a Selim, Magdy H |e verfasserin |4 aut | |
| 700 | 1 | |a Alexandrov, Andrei V |e verfasserin |4 aut | |
| 700 | 1 | |a Tsivgoulis, Georgios |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of neurology |d 1974 |g 267(2020), 4 vom: 17. Apr., Seite 1053-1062 |w (DE-627)NLM000508543 |x 1432-1459 |7 nnns |
| 773 | 1 | 8 | |g volume:267 |g year:2020 |g number:4 |g day:17 |g month:04 |g pages:1053-1062 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1007/s00415-019-09678-2 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 267 |j 2020 |e 4 |b 17 |c 04 |h 1053-1062 | ||