Lancet Neurology-After intracerebral hemorrhage, whether it recurs depends on what factors?

Worldwide, strokes caused by spontaneous (non-traumatic) intracerebral hemorrhage (ICH) account for about a quarter of all strokes, but due to the subsequent risk of death, disability, and serious vascular events, almost account for strokes.
Disability adjusts half of life years
.

Adults with ICH usually have underlying small blood vessel disease in the brain, which puts them at risk of recurring stroke, and has systemic comorbidities, which puts them at additional risk of stroke and other cardiovascular events

Vascular cardiovascular events

In general, ICH survivors seem to have a similar annual risk of recurring ICH and ischemic stroke
.

However, most of these estimates of the risk of stroke recurrence come from hospital research

Stroke

Identifying the risk factors for recurrence of ICH, ischemic stroke and all serious vascular events after ICH can help risk stratification and provide a basis for decision-making on antithrombotic drugs after ICH
.

In some studies, the location of lobar ICH is associated with a high risk of recurrent ICH, but not in other studies

Thrombosis but atrial fibrillation (AF) may be a risk factor for ischemic stroke, but not for recurrent ICH

First, although there is no evidence in RESTART that the effect of antiplatelet therapy is heterogeneous in the location of ICH, participants with non-phyllodes ICH may benefit more than those with phyllodes ICH
.

Second, RESTART recruited one of 12 eligible patients with an average ICH volume of about 4 ml.

Therefore, Linxin Li of the University of Oxford and others analyzed two contemporary prospective, population-based cohort studies in the UK to resolve three uncertainties: First, among unselected ICH patients, according to ICH location and combined AF Stratification, the absolute and relative risks of recurrence of ICH and ischemic stroke; second, the risk of all serious vascular events after ICH; and third, the prevalence of RESTART
.

They brought together Oxfordshire, England (Oxfordshire Vascular Study; April 1, 2002 to September 28, 2018) and Lothian, Scotland, United Kingdom (Lothian Audit of the Treatment of Cerebral Haemorrhage; June 1, 2010 to 2013 May 31) Individual patient data for all accidental ICH patients in two prospective, population-based initial cohort studies
.

It also quantifies the absolute and relative risks of recurrent ICH, ischemic stroke or any serious vascular event (non-fatal stroke, non-fatal myocardial infarction, or vascular death), according to the position of ICH (lobed and non-lobed) and Combined with atrial fibrillation (AF) stratification

But there is no evidence that there is a difference in the risk of ischemic stroke
.

In contrast, there is no evidence that there is a difference in the rate of recurrent ICH between patients with atrial fibrillation and non-AF patients, but patients with atrial fibrillation have a higher risk of ischemic stroke, so patients with atrial fibrillation have a higher risk of all serious vascular events than those without atrial fibrillation Patient

But there is no evidence that there is a difference in the risk of ischemic stroke

Only in patients with lobar ICH without atrial fibrillation, the risk of recurrence of ICH is greater than the risk of ischemic stroke

Original source:
Li L, Poon MTC, Samarasekera NE, Perry LA, Moullaali TJ, Rodrigues MA, Loan JJM, Stephen J, Lerpiniere C, Tuna MA, Gutnikov SA, Kuker W, Silver LE, Al-Shahi Salman R, Rothwell PM .
Risks of recurrent stroke and all serious vascular events after spontaneous intracerebral haemorrhage: pooled analyses of two population-based studies.
Lancet Neurol.
2021 Jun;20(6):437-447.
doi: 10.
1016/S1474-4422(21)00075 -2.
Erratum in: Lancet Neurol.
2021 Jun 9;: PMID: 34022170; PMCID: PMC8134058.

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