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 & 6 others Carl D. Langefeld, Michael L. James, Sebastian Koch, Hagen B. Huttner, Alessandro Biffi, Kevin N. Sheth

Research output: Contribution to journalArticle

Abstract

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 CHA2DS2-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 CHA2DS2-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 CHA2DS2-VASc score (odds ratio, 1.89; 95% CI, 1.32-2.70). We found an interaction between CHA2DS2-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.

Original languageEnglish (US)
Pages (from-to)2652-2658
Number of pages7
JournalStroke
Volume49
Issue number11
DOIs
StatePublished - Nov 1 2018
Externally publishedYes

Fingerprint

Cerebral Hemorrhage
Stroke
brotizolam
Odds Ratio
General Hospitals
Atrial Fibrillation
Multicenter Studies
Observational Studies
Therapeutics

Keywords

  • anticoagulation
  • atrial fibrillation
  • hemorrhage
  • mortality
  • risk
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Murphy, M. P., Kuramatsu, J. B., Leasure, A., Falcone, G. J., Kamel, H., Sansing, L. H., ... Sheth, K. N. (2018). Cardioembolic Stroke Risk and Recovery After Anticoagulation-Related Intracerebral Hemorrhage. Stroke, 49(11), 2652-2658. https://doi.org/10.1161/STROKEAHA.118.021799

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

In: Stroke, Vol. 49, No. 11, 01.11.2018, p. 2652-2658.

Research output: Contribution to journalArticle

Murphy, MP, Kuramatsu, JB, Leasure, A, Falcone, GJ, Kamel, H, Sansing, LH, Kourkoulis, C, Schwab, K, Elm, JJ, Gurol, ME, Tran, H, Greenberg, SM, Viswanathan, A, Anderson, CD, Schwab, S, Rosand, J, Shi, FD, Kittner, SJ, Testai, FD, Woo, D, Langefeld, CD, James, ML, Koch, S, Huttner, HB, Biffi, A & Sheth, KN 2018, 'Cardioembolic Stroke Risk and Recovery After Anticoagulation-Related Intracerebral Hemorrhage', Stroke, vol. 49, no. 11, pp. 2652-2658. https://doi.org/10.1161/STROKEAHA.118.021799
Murphy MP, Kuramatsu JB, Leasure A, Falcone GJ, Kamel H, Sansing LH et al. Cardioembolic Stroke Risk and Recovery After Anticoagulation-Related Intracerebral Hemorrhage. Stroke. 2018 Nov 1;49(11):2652-2658. https://doi.org/10.1161/STROKEAHA.118.021799
Murphy, Meredith P. ; Kuramatsu, Joji B. ; Leasure, Audrey ; Falcone, Guido J. ; Kamel, Hooman ; Sansing, Lauren H. ; Kourkoulis, Christina ; Schwab, Kristin ; Elm, Jordan J. ; Gurol, M. Edip ; Tran, Huy ; Greenberg, Steven M. ; Viswanathan, Anand ; Anderson, Christopher D. ; Schwab, Stefan ; Rosand, Jonathan ; Shi, Fu Dong ; Kittner, Steven J. ; Testai, Fernando D. ; Woo, Daniel ; Langefeld, Carl D. ; James, Michael L. ; Koch, Sebastian ; Huttner, Hagen B. ; Biffi, Alessandro ; Sheth, Kevin N. / Cardioembolic Stroke Risk and Recovery After Anticoagulation-Related Intracerebral Hemorrhage. In: Stroke. 2018 ; Vol. 49, No. 11. pp. 2652-2658.
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T1 - Cardioembolic Stroke Risk and Recovery After Anticoagulation-Related Intracerebral Hemorrhage

AU - Murphy, Meredith P.

AU - Kuramatsu, Joji B.

AU - Leasure, Audrey

AU - Falcone, Guido J.

AU - Kamel, Hooman

AU - Sansing, Lauren H.

AU - Kourkoulis, Christina

AU - Schwab, Kristin

AU - Elm, Jordan J.

AU - Gurol, M. Edip

AU - Tran, Huy

AU - Greenberg, Steven M.

AU - Viswanathan, Anand

AU - Anderson, Christopher D.

AU - Schwab, Stefan

AU - Rosand, Jonathan

AU - Shi, Fu Dong

AU - Kittner, Steven J.

AU - Testai, Fernando D.

AU - Woo, Daniel

AU - Langefeld, Carl D.

AU - James, Michael L.

AU - Koch, Sebastian

AU - Huttner, Hagen B.

AU - Biffi, Alessandro

AU - Sheth, Kevin N.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - 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 CHA2DS2-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 CHA2DS2-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 CHA2DS2-VASc score (odds ratio, 1.89; 95% CI, 1.32-2.70). We found an interaction between CHA2DS2-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.

AB - 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 CHA2DS2-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 CHA2DS2-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 CHA2DS2-VASc score (odds ratio, 1.89; 95% CI, 1.32-2.70). We found an interaction between CHA2DS2-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.

KW - anticoagulation

KW - atrial fibrillation

KW - hemorrhage

KW - mortality

KW - risk

KW - stroke

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