Vascular risk stratification after spontaneous cerebral hemorrhage

This article is from the NEJM Journal Watch Stratifying Vascular Risk After Spontaneous Intracerebral Hemorrhage Comment by Anthony S.
Kim, MD in a pooled analysis of two cohorts of patients with massive cerebral hemorrhage Among them, lobar hemorrhage and atrial fibrillation increase the risk of recurrent cerebral hemorrhage or ischemic stroke
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Spontaneous cerebral hemorrhage is associated with an increased risk of recurrent hemorrhagic stroke and new ischemic stroke
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The above-mentioned possibilities make anti-thrombotic strategies face a dilemma, because one is recurrent bleeding and the other is ischemia
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Past data suggest that the two possibilities are roughly equal.
Most of these data come from hospital cohorts and are prone to selection bias
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Researchers have now merged individual patient data from two population-based prospective cohort studies, including 674 patients with first-time cerebral hemorrhage
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During a total of 1,553 person-years of follow-up, the incidence of recurrent cerebral hemorrhage was 3.
2 cases per 100 patient-years, and the incidence of ischemic stroke was 1.
7 cases per 100 patient-years
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The incidence of recurrent intracerebral hemorrhage in patients with cerebral lobe hemorrhage is higher than that in patients with other sites other than lobe hemorrhage (5.
1 cases and 1.
8 cases per 100 patients-years, respectively), but the incidence of ischemic stroke is similar regardless of the location of cerebral hemorrhage (Respectively 1.
8 cases and 1.
6 cases per 100 patient-years)
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In contrast, the incidence of recurrent intracerebral hemorrhage was similar between patients with and without atrial fibrillation (3.
3 and 3.
2 per 100 patient-years, respectively), while patients with atrial fibrillation had ischemia The incidence of sexual stroke was higher than that of patients without atrial fibrillation (6.
3 cases and 0.
7 cases per 100 patient-years, respectively)
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Vascular events (including non-fatal myocardial infarction or death from vascular causes) are more common in patients with atrial fibrillation (15.
5 vs.
6.
8 per 100 patient-years)
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These results confirm the results of patients who avoided antiplatelet therapy in the RESTART randomized trial.
RESTART included patients who received antithrombotic therapy before cerebral hemorrhage and compared restarting antiplatelet therapy with avoidance of antiplatelet therapy (Lancet 2019; 393:2613)
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Comment on lobar hemorrhage and atrial fibrillation make it very difficult to make antithrombotic treatment decisions after cerebral hemorrhage, which is confirmed in this observational study (the incidence of recurrent cerebral hemorrhage in patients with cerebral hemorrhage is high, and atrial fibrillation Patients not only have a high incidence of ischemic stroke, but also have a high incidence of recurrent cerebral hemorrhage and vascular events)
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The ongoing ASPIRE trial (Anticoagulation in ICH Survivors for Stroke Prevention and Recovery) (NCT03907046) is expected to provide data indicating that for such patients, apixaban and Which is better for aspirin
?
Commented article Li L et al.
Risks of recurrent stroke and all serious vascular events after spontaneous intracerebral haemorrhage: Pooled analyses of two population-based studies.
Lancet Neurol 2021 Jun; 20:437.
(https://doi.
org/10.
1016 /S1474-4422(21)00075-2) NEJM Journal Watch is published by NEJM Group.
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