The Intracranial-B2LEED3S score and the risk of intracranial hemorrhage in ischemic stroke patients under antiplatelet treatment.
<p><strong><em>Background</em></strong>Chronic antiplatelet therapy in the post-acute phase of non-cardioembolic ischemic stroke is limited by the risk of intracranial hemorrhage (ICH) complications.</p> <p><strong><em>Methods</em></stro...
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Karger
2017
|
| _version_ | 1826298557995417600 |
|---|---|
| author | Amarenco, P Sissani, L Labreuche, J Vicaut, E Bousser, MG Chamorro, A Fisher, M Ford, I Fox, KM Hennerici, MG Mattle, H Rothwell, PM Steg, PG Diener, H-C Sacco, RL Greving, JP Algra, A |
| author_facet | Amarenco, P Sissani, L Labreuche, J Vicaut, E Bousser, MG Chamorro, A Fisher, M Ford, I Fox, KM Hennerici, MG Mattle, H Rothwell, PM Steg, PG Diener, H-C Sacco, RL Greving, JP Algra, A |
| author_sort | Amarenco, P |
| collection | OXFORD |
| description | <p><strong><em>Background</em></strong>Chronic antiplatelet therapy in the post-acute phase of non-cardioembolic ischemic stroke is limited by the risk of intracranial hemorrhage (ICH) complications.</p> <p><strong><em>Methods</em></strong>We developed an ICH risk score based on the PERFORM trial cohort (n = 19,100), which included patients with a non-cardioembolic ischemic stroke or transient ischemic attack, and externally validated this score in one contemporary trial of very similar size and inclusion criteria, the PRoFESS trial (n = 20,332 patients). Outcome was ICH over 2 years. A Cox proportional-hazard regression analysis identified risk factors. Discrimination was quantified with c-statistics and calibration was assessed by comparing predicted and observed ICH risk in PERFORM and PRoFESS.</p> <p><strong><em>Results</em></strong>ICH occurred within 2 years in 263 (1.4%) patients in PERFORM trial and in 246 (1.2%) patients in PRoFESS trial. A 13-point score based on 9 items (Intracranial-B2LEED3S score - low body mass index, blood pressure, lacune, elderly, Asian ethnicity, coronary artery or cerebrovascular disease history, dual antithrombotic agent or oral anticoagulant, gender) was derived from the PERFORM trial. In PERFORM, the observed 2-year ICH risk varied from 0.75% in low-risk (score ≤2) to 2.44% in high-risk patients (score ≥5) with an acceptable calibration but a low discrimination both in PERFORM (c-statistic 0.64, 95% CI 0.61-0.68) and on external validation in PRoFESS (0.58, 95% CI 0.55-0.62).</p> <p><strong><em>Conclusion</em></strong>The Intracranial-B<sub>2</sub>LEED<sub>3</sub>S score helps identify patients who are at a high risk of bleeding. However, other variables need to be identified to improve the score (e.g., microbleeds) (Clinical Trial Registration Information ISRCTN66157730). URL: https://doi.org/10.1186/ISRCTN66157730</p> |
| first_indexed | 2024-03-07T04:48:41Z |
| format | Journal article |
| id | oxford-uuid:d436fa76-2e58-44e7-91a3-478adefff29a |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T04:48:41Z |
| publishDate | 2017 |
| publisher | Karger |
| record_format | dspace |
| spelling | oxford-uuid:d436fa76-2e58-44e7-91a3-478adefff29a2022-03-27T08:16:47ZThe Intracranial-B2LEED3S score and the risk of intracranial hemorrhage in ischemic stroke patients under antiplatelet treatment.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:d436fa76-2e58-44e7-91a3-478adefff29aEnglishSymplectic Elements at OxfordKarger2017Amarenco, PSissani, LLabreuche, JVicaut, EBousser, MGChamorro, AFisher, MFord, IFox, KMHennerici, MGMattle, HRothwell, PMSteg, PGDiener, H-CSacco, RLGreving, JPAlgra, A<p><strong><em>Background</em></strong>Chronic antiplatelet therapy in the post-acute phase of non-cardioembolic ischemic stroke is limited by the risk of intracranial hemorrhage (ICH) complications.</p> <p><strong><em>Methods</em></strong>We developed an ICH risk score based on the PERFORM trial cohort (n = 19,100), which included patients with a non-cardioembolic ischemic stroke or transient ischemic attack, and externally validated this score in one contemporary trial of very similar size and inclusion criteria, the PRoFESS trial (n = 20,332 patients). Outcome was ICH over 2 years. A Cox proportional-hazard regression analysis identified risk factors. Discrimination was quantified with c-statistics and calibration was assessed by comparing predicted and observed ICH risk in PERFORM and PRoFESS.</p> <p><strong><em>Results</em></strong>ICH occurred within 2 years in 263 (1.4%) patients in PERFORM trial and in 246 (1.2%) patients in PRoFESS trial. A 13-point score based on 9 items (Intracranial-B2LEED3S score - low body mass index, blood pressure, lacune, elderly, Asian ethnicity, coronary artery or cerebrovascular disease history, dual antithrombotic agent or oral anticoagulant, gender) was derived from the PERFORM trial. In PERFORM, the observed 2-year ICH risk varied from 0.75% in low-risk (score ≤2) to 2.44% in high-risk patients (score ≥5) with an acceptable calibration but a low discrimination both in PERFORM (c-statistic 0.64, 95% CI 0.61-0.68) and on external validation in PRoFESS (0.58, 95% CI 0.55-0.62).</p> <p><strong><em>Conclusion</em></strong>The Intracranial-B<sub>2</sub>LEED<sub>3</sub>S score helps identify patients who are at a high risk of bleeding. However, other variables need to be identified to improve the score (e.g., microbleeds) (Clinical Trial Registration Information ISRCTN66157730). URL: https://doi.org/10.1186/ISRCTN66157730</p> |
| spellingShingle | Amarenco, P Sissani, L Labreuche, J Vicaut, E Bousser, MG Chamorro, A Fisher, M Ford, I Fox, KM Hennerici, MG Mattle, H Rothwell, PM Steg, PG Diener, H-C Sacco, RL Greving, JP Algra, A The Intracranial-B2LEED3S score and the risk of intracranial hemorrhage in ischemic stroke patients under antiplatelet treatment. |
| title | The Intracranial-B2LEED3S score and the risk of intracranial hemorrhage in ischemic stroke patients under antiplatelet treatment. |
| title_full | The Intracranial-B2LEED3S score and the risk of intracranial hemorrhage in ischemic stroke patients under antiplatelet treatment. |
| title_fullStr | The Intracranial-B2LEED3S score and the risk of intracranial hemorrhage in ischemic stroke patients under antiplatelet treatment. |
| title_full_unstemmed | The Intracranial-B2LEED3S score and the risk of intracranial hemorrhage in ischemic stroke patients under antiplatelet treatment. |
| title_short | The Intracranial-B2LEED3S score and the risk of intracranial hemorrhage in ischemic stroke patients under antiplatelet treatment. |
| title_sort | intracranial b2leed3s score and the risk of intracranial hemorrhage in ischemic stroke patients under antiplatelet treatment |
| work_keys_str_mv | AT amarencop theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT sissanil theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT labreuchej theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT vicaute theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT boussermg theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT chamorroa theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT fisherm theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT fordi theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT foxkm theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT hennericimg theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT mattleh theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT rothwellpm theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT stegpg theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT dienerhc theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT saccorl theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT grevingjp theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT algraa theintracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT amarencop intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT sissanil intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT labreuchej intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT vicaute intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT boussermg intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT chamorroa intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT fisherm intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT fordi intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT foxkm intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT hennericimg intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT mattleh intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT rothwellpm intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT stegpg intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT dienerhc intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT saccorl intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT grevingjp intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment AT algraa intracranialb2leed3sscoreandtheriskofintracranialhemorrhageinischemicstrokepatientsunderantiplatelettreatment |