Cardioembolic Stroke Risk and Recovery After Anticoagulation-Related Intracerebral Hemorrhage

Meredith P Murphy; Joji B Kuramatsu; Audrey Leasure; Guido J Falcone; Hooman Kamel; Lauren H Sansing; Christina Kourkoulis; Kristin Schwab; Jordan J Elm; M Edip Gurol; Huy Tran; Steven M Greenberg; Anand Viswanathan; Christopher D Anderson; Stefan Schwab; Jonathan Rosand; Fu-Dong Shi; Steven J Kittner; Fernando D Testai; Daniel Woo; Carl D Langefeld; Michael L James; Sebastian Koch; Hagen B Huttner; Alessandro Biffi; Kevin N Sheth

doi:10.1161/STROKEAHA.118.021799

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Cardioembolic Stroke Risk and Recovery After Anticoagulation-Related Intracerebral Hemorrhage

Journal article

Open access

Peer reviewed

Cardioembolic Stroke Risk and Recovery After Anticoagulation-Related Intracerebral Hemorrhage

Meredith P Murphy, Joji B Kuramatsu, Audrey Leasure, Guido J Falcone, Hooman Kamel, Lauren H Sansing, Christina Kourkoulis, Kristin Schwab, Jordan J Elm, M Edip Gurol, …

Stroke (1970), Vol.49(11), pp.2652-2658

2018-11

DOI: https://doi.org/10.1161/STROKEAHA.118.021799

PMCID: PMC6211810

PMID: 30355194

Abstract

Aged

Aged, 80 and over

Anticoagulants - adverse effects

Anticoagulants - therapeutic use

Atrial Fibrillation - complications

Atrial Fibrillation - drug therapy

Cerebral Hemorrhage - chemically induced

Female

Humans

Intracranial Embolism - epidemiology

Intracranial Embolism - etiology

Intracranial Embolism - prevention & control

Logistic Models

Male

Middle Aged

Multivariate Analysis

Recovery of Function

Risk Assessment

Stroke - epidemiology

Stroke - etiology

Stroke - prevention & control

Background and Purpose- Whether to resume oral anticoagulation treatment after intracerebral hemorrhage (ICH) remains an unresolved question. Previous studies focused primarily on recurrent stroke after ICH. We sought to investigate the association between cardioembolic stroke risk, oral anticoagulation therapy resumption, and functional recovery among ICH survivors in the absence of recurrent stroke. Methods- We conducted a joint analysis of 3 observational studies: (1) the multicenter RETRACE study (German-Wide Multicenter Analysis of Oral Anticoagulation Associated Intracerebral Hemorrhage); (2) the Massachusetts General Hospital ICH study (n=166); and (3) the ERICH study (Ethnic/Racial Variations of Intracerebral Hemorrhage; n=131). We included 941 survivors of ICH in the setting of active oral anticoagulation therapy for prevention of cardioembolic stroke because of nonvalvular atrial fibrillation and without evidence of ischemic stroke and recurrent ICH at 1 year from the index event. We created univariable and multivariable models to explore associations between cardioembolic stroke risk (based on CHA DS -VASc scores) and functional recovery after ICH, defined as achieving modified Rankin Scale score of ≤3 at 1 year for participants with modified Rankin Scale score of >3 at discharge. Results- In multivariable analyses, the CHA DS -VASc score was associated with a decreased likelihood of functional recovery (odds ratio, 0.83 per 1 point increase; 95% CI, 0.79-0.86) at 1 year. Anticoagulation resumption was independently associated with a higher likelihood of recovery, regardless of CHA DS -VASc score (odds ratio, 1.89; 95% CI, 1.32-2.70). We found an interaction between CHA DS -VASc score and anticoagulation resumption in terms of association with increased likelihood of functional recovery (interaction P=0.011). Conclusions- Increasing cardioembolic stroke risk is associated with a decreased likelihood of functional recovery at 1 year after ICH, but this association was weaker among participants resuming oral anticoagulation therapy. These findings support, including recovery metrics, in future studies of anticoagulation resumption after ICH.

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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.94 Cardiac Arrhythmia; 1.94.95 Atrial Fibrillation
Web Of Science research areas: Clinical Neurology; Peripheral Vascular Disease
ESI research areas: Neuroscience & Behavior

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Title: Cardioembolic Stroke Risk and Recovery After Anticoagulation-Related Intracerebral Hemorrhage
Creators: Meredith P Murphy - Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
Joji B Kuramatsu - Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany (J.B.K., S.S., H.B.H.)
Audrey Leasure - Divisions of Neurocritical Care & Emergency Neurology and Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (A.L., G.J.F., L.H.S., K.N.S.)
Guido J Falcone - Divisions of Neurocritical Care & Emergency Neurology and Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (A.L., G.J.F., L.H.S., K.N.S.)
Hooman Kamel - Department of Neurology, Weill Cornell College of Medicine, New York, NY (H.K.)
Lauren H Sansing - Divisions of Neurocritical Care & Emergency Neurology and Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (A.L., G.J.F., L.H.S., K.N.S.)
Christina Kourkoulis - Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
Kristin Schwab - Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
Jordan J Elm - Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.J.E.)
M Edip Gurol - Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
Huy Tran - Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque (H.T.)
Steven M Greenberg - Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
Anand Viswanathan - Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
Christopher D Anderson - Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
Stefan Schwab - Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany (J.B.K., S.S., H.B.H.)
Jonathan Rosand - Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
Fu-Dong Shi - Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (F.-D.S.)
Steven J Kittner - Department of Neurology, Baltimore VA Medical Center, University of Maryland School of Medicine, Baltimore (S.J.K.)
Fernando D Testai - Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago (F.D.T.)
Daniel Woo - Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (D.W.)
Carl D Langefeld - Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.D.L.)
Michael L James - Department of Anesthesiology, Duke University, Durham, NC (M.L.J.)
Sebastian Koch - Baltimore Veterans Administration Medical Center, University of Maryland, Baltimore (S.K.)
Hagen B Huttner - Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany (J.B.K., S.S., H.B.H.)
Alessandro Biffi - Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
Kevin N Sheth - Divisions of Neurocritical Care & Emergency Neurology and Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (A.L., G.J.F., L.H.S., K.N.S.)
Publication Details: Stroke (1970), Vol.49(11), pp.2652-2658
Grant note: K23 NS100816 / NINDS NIH HHS R01 NS093870 / NINDS NIH HHS P30 AG021342 / NIA NIH HHS R01 NR018335 / NINR NIH HHS U01 NS106513 / NINDS NIH HHS U24 NS107136 / NINDS NIH HHS K23 NS083711 / NINDS NIH HHS U24 NS107215 / NINDS NIH HHS
Academic Unit: Miller School of Medicine; Division of Continuing & International Education (DCIE); UMMG Department of Neurology; UMMG Dept of Neurology - Stroke Div; DCIE - Intensive English Program
Language: English
Resource Type: Journal article
PMID: 30355194
PMCID: PMC6211810
Record Identifier: 991031613536902976