Risk of Ischemic Stroke after Intracranial Hemorrhage in Patients with Atrial Fibrillation.
<h4>Background</h4>We aimed to estimate the risk of ischemic stroke after intracranial hemorrhage in patients with atrial fibrillation.<h4>Materials and methods</h4>Using discharge data from all nonfederal acute care hospitals and emergency departments in California, Florida,...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2015-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0145579&type=printable |
| _version_ | 1826584433723965440 |
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| author | Michael P Lerario Gino Gialdini Daniel M Lapidus Mesha M Shaw Babak B Navi Alexander E Merkler Gregory Y H Lip Jeff S Healey Hooman Kamel |
| author_facet | Michael P Lerario Gino Gialdini Daniel M Lapidus Mesha M Shaw Babak B Navi Alexander E Merkler Gregory Y H Lip Jeff S Healey Hooman Kamel |
| author_sort | Michael P Lerario |
| collection | DOAJ |
| description | <h4>Background</h4>We aimed to estimate the risk of ischemic stroke after intracranial hemorrhage in patients with atrial fibrillation.<h4>Materials and methods</h4>Using discharge data from all nonfederal acute care hospitals and emergency departments in California, Florida, and New York from 2005 to 2012, we identified patients at the time of a first-recorded encounter with a diagnosis of atrial fibrillation. Ischemic stroke and intracranial hemorrhage were identified using validated diagnosis codes. Kaplan-Meier survival statistics and Cox proportional hazard analyses were used to evaluate cumulative rates of ischemic stroke and the relationship between incident intracranial hemorrhage and subsequent stroke.<h4>Results</h4>Among 2,084,735 patients with atrial fibrillation, 50,468 (2.4%) developed intracranial hemorrhage and 89,594 (4.3%) developed ischemic stroke during a mean follow-up period of 3.2 years. The 1-year cumulative rate of stroke was 8.1% (95% CI, 7.5-8.7%) after intracerebral hemorrhage, 3.9% (95% CI, 3.5-4.3%) after subdural hemorrhage, and 2.0% (95% CI, 2.0-2.1%) in those without intracranial hemorrhage. After adjustment for the CHA2DS2-VASc score, stroke risk was elevated after both intracerebral hemorrhage (hazard ratio [HR], 2.8; 95% CI, 2.6-2.9) and subdural hemorrhage (HR, 1.6; 95% CI, 1.5-1.7). Cumulative 1-year rates of stroke ranged from 0.9% in those with subdural hemorrhage and a CHA2DS2-VASc score of 0, to 33.3% in those with intracerebral hemorrhage and a CHA2DS2-VASc score of 9.<h4>Conclusions</h4>In a large, heterogeneous cohort, patients with atrial fibrillation faced a substantially heightened risk of ischemic stroke after intracranial hemorrhage. The risk was most marked in those with intracerebral hemorrhage and high CHA2DS2-VASc scores. |
| first_indexed | 2024-12-12T09:53:51Z |
| format | Article |
| id | doaj.art-5f7e1a64901a4ca683888d74c6400cf4 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2025-03-14T15:37:41Z |
| publishDate | 2015-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-5f7e1a64901a4ca683888d74c6400cf42025-02-25T05:31:57ZengPublic Library of Science (PLoS)PLoS ONE1932-62032015-01-011012e014557910.1371/journal.pone.0145579Risk of Ischemic Stroke after Intracranial Hemorrhage in Patients with Atrial Fibrillation.Michael P LerarioGino GialdiniDaniel M LapidusMesha M ShawBabak B NaviAlexander E MerklerGregory Y H LipJeff S HealeyHooman Kamel<h4>Background</h4>We aimed to estimate the risk of ischemic stroke after intracranial hemorrhage in patients with atrial fibrillation.<h4>Materials and methods</h4>Using discharge data from all nonfederal acute care hospitals and emergency departments in California, Florida, and New York from 2005 to 2012, we identified patients at the time of a first-recorded encounter with a diagnosis of atrial fibrillation. Ischemic stroke and intracranial hemorrhage were identified using validated diagnosis codes. Kaplan-Meier survival statistics and Cox proportional hazard analyses were used to evaluate cumulative rates of ischemic stroke and the relationship between incident intracranial hemorrhage and subsequent stroke.<h4>Results</h4>Among 2,084,735 patients with atrial fibrillation, 50,468 (2.4%) developed intracranial hemorrhage and 89,594 (4.3%) developed ischemic stroke during a mean follow-up period of 3.2 years. The 1-year cumulative rate of stroke was 8.1% (95% CI, 7.5-8.7%) after intracerebral hemorrhage, 3.9% (95% CI, 3.5-4.3%) after subdural hemorrhage, and 2.0% (95% CI, 2.0-2.1%) in those without intracranial hemorrhage. After adjustment for the CHA2DS2-VASc score, stroke risk was elevated after both intracerebral hemorrhage (hazard ratio [HR], 2.8; 95% CI, 2.6-2.9) and subdural hemorrhage (HR, 1.6; 95% CI, 1.5-1.7). Cumulative 1-year rates of stroke ranged from 0.9% in those with subdural hemorrhage and a CHA2DS2-VASc score of 0, to 33.3% in those with intracerebral hemorrhage and a CHA2DS2-VASc score of 9.<h4>Conclusions</h4>In a large, heterogeneous cohort, patients with atrial fibrillation faced a substantially heightened risk of ischemic stroke after intracranial hemorrhage. The risk was most marked in those with intracerebral hemorrhage and high CHA2DS2-VASc scores.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0145579&type=printable |
| spellingShingle | Michael P Lerario Gino Gialdini Daniel M Lapidus Mesha M Shaw Babak B Navi Alexander E Merkler Gregory Y H Lip Jeff S Healey Hooman Kamel Risk of Ischemic Stroke after Intracranial Hemorrhage in Patients with Atrial Fibrillation. PLoS ONE |
| title | Risk of Ischemic Stroke after Intracranial Hemorrhage in Patients with Atrial Fibrillation. |
| title_full | Risk of Ischemic Stroke after Intracranial Hemorrhage in Patients with Atrial Fibrillation. |
| title_fullStr | Risk of Ischemic Stroke after Intracranial Hemorrhage in Patients with Atrial Fibrillation. |
| title_full_unstemmed | Risk of Ischemic Stroke after Intracranial Hemorrhage in Patients with Atrial Fibrillation. |
| title_short | Risk of Ischemic Stroke after Intracranial Hemorrhage in Patients with Atrial Fibrillation. |
| title_sort | risk of ischemic stroke after intracranial hemorrhage in patients with atrial fibrillation |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0145579&type=printable |
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