Risk of Cerebrovascular Events in Intracerebral Hemorrhage Survivors With Atrial Fibrillation: A Nationwide Cohort Study



Nielsen, Peter Bronnum, Melgaard, Line, Overvad, Thure Filskov, Jensen, Martin, Larsen, Torben Bjerregaard and Lip, Gregory YH ORCID: 0000-0002-7566-1626
(2022) Risk of Cerebrovascular Events in Intracerebral Hemorrhage Survivors With Atrial Fibrillation: A Nationwide Cohort Study. STROKE, 53 (8). pp. 2559-2568.

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Abstract

<h4>Background</h4>In patients with intracerebral hemorrhage (ICH) and prevalent atrial fibrillation (AF), the optimal stroke prevention strategy is unclear. We sought to estimate the risk of cerebrovascular events among ICH survivors with AF.<h4>Methods</h4>We used the Danish Stroke Registry to identify patients with incident ICH and prevalent AF between 2003 and 2018. Key inclusion/exclusion criteria of the PRESTIGE-AF (Prevention of Stroke in Intracerebral hemorrhage Survivors With Atrial Fibrillation) trial were applied. Cumulative incidence of recurrent ICH, cerebrovascular ischemic event, and all-cause death were investigated after one year.<h4>Results</h4>A total of 1885 patients (median age 80.0 years; 47.6% females) were included in the study. We observed 191 cerebrovascular events and 650 all-cause deaths, and more cerebrovascular ischemic events (N=63) than recurrent ICH events (N=40). Risks of recurrent ICH, cerebrovascular ischemic event, and all-cause death were 1.5%, 3.2%, and 30.3%, respectively, among patients not exposed to OAC during follow-up. The cumulative incidences were 2.8% for recurrent ICH, 3.2% for cerebrovascular ischemic events, and 22.0% for all-cause death among patients initiating/resuming OAC during follow-up.<h4>Conclusions</h4>We observed a high risk of cerebrovascular ischemic events and a very high risk of all-cause death at one year after the incident ICH. The results of ongoing clinical trials are warranted to determine optimal stroke prevention treatment among ICH survivors with concomitant AF.

Item Type: Article
Uncontrolled Keywords: anticoagulants, atrial fibrillation, epidemiology, hemorrhagic stroke, ischemic stroke
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 13 May 2022 14:56
Last Modified: 18 Jan 2023 21:03
DOI: 10.1161/STROKEAHA.121.038331
Open Access URL: https://www.ahajournals.org/doi/10.1161/STROKEAHA....
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3154766