BACKGROUND AND PURPOSE: The decision to prescribe oral anticoagulant therapy in patients with atrial fibrillation is based on an assessment of the competing risks of ischemic stroke and major bleeding, of which intracerebral hemorrhage (ICH) is the most important type. We sought to determine the comparative importance of risk factors for ischemic stroke and ICH in patients with acute stroke and atrial fibrillation with particular emphasis on risk factors common to both stroke types. METHODS: Consecutive patients with acute ischemic stroke or ICH and atrial fibrillation included in the Registry of the Canadian Stroke Network constituted the cohort. Multivariable logistic regression analysis was used to determine the association between baseline risk factors and presentation with ICH versus ischemic stroke. Risk factors included: (1) those previously reported to be risk factors for both ischemic stroke and major bleeding (particularly ICH) ("shared" risk factors, including age, alcohol, hypertension, diabetes mellitus, renal impairment, prior stroke/transient ischemic attack and preadmission dementia); and (2) other risk factors associated with either stroke subtype alone. RESULTS: A total of 3197 patients presented with atrial fibrillation and acute stroke, of which 12.2% presented with ICH. Of the "shared" risk factors, age (OR, 1.19; 95% CI, 1.06-1.34 per decade) and prior stroke/transient ischemic attack (OR, 1.45; 95% CI, 1.12-1.87) were more associated with ischemic stroke than ICH, whereas a history of hypertension (OR, 0.89; 95% CI, 0.68-1.17), diabetes mellitus (OR 1.23; 95% CI, 0.92-1.64), renal impairment (OR, 1.28; 95% CI, 0.95-1.71), and alcohol intake were not more strongly associated with either stroke subtype. CONCLUSION: Of the risk factors known to be associated with both ischemic stroke and ICH in patients with atrial fibrillation, we found that none had a stronger association with ICH. Older age was more strongly associated with ischemic stroke than ICH.
BACKGROUND AND PURPOSE: The decision to prescribe oral anticoagulant therapy in patients with atrial fibrillation is based on an assessment of the competing risks of ischemic stroke and major bleeding, of which intracerebral hemorrhage (ICH) is the most important type. We sought to determine the comparative importance of risk factors for ischemic stroke and ICH in patients with acute stroke and atrial fibrillation with particular emphasis on risk factors common to both stroke types. METHODS: Consecutive patients with acute ischemic stroke or ICH and atrial fibrillation included in the Registry of the Canadian Stroke Network constituted the cohort. Multivariable logistic regression analysis was used to determine the association between baseline risk factors and presentation with ICH versus ischemic stroke. Risk factors included: (1) those previously reported to be risk factors for both ischemic stroke and major bleeding (particularly ICH) ("shared" risk factors, including age, alcohol, hypertension, diabetes mellitus, renal impairment, prior stroke/transient ischemic attack and preadmission dementia); and (2) other risk factors associated with either stroke subtype alone. RESULTS: A total of 3197 patients presented with atrial fibrillation and acute stroke, of which 12.2% presented with ICH. Of the "shared" risk factors, age (OR, 1.19; 95% CI, 1.06-1.34 per decade) and prior stroke/transient ischemic attack (OR, 1.45; 95% CI, 1.12-1.87) were more associated with ischemic stroke than ICH, whereas a history of hypertension (OR, 0.89; 95% CI, 0.68-1.17), diabetes mellitus (OR 1.23; 95% CI, 0.92-1.64), renal impairment (OR, 1.28; 95% CI, 0.95-1.71), and alcohol intake were not more strongly associated with either stroke subtype. CONCLUSION: Of the risk factors known to be associated with both ischemic stroke and ICH in patients with atrial fibrillation, we found that none had a stronger association with ICH. Older age was more strongly associated with ischemic stroke than ICH.
Authors: Achint A Patel; Abhimanyu Mahajan; Alexandre Benjo; Ambarish Pathak; Jitesh Kar; Vishal B Jani; Narender Annapureddy; Shiv Kumar Agarwal; Manpreet S Sabharwal; Priya K Simoes; Ioannis Konstantinidis; Rabi Yacoub; Fahad Javed; Georges El Hayek; Madhav C Menon; Girish N Nadkarni Journal: Neurohospitalist Date: 2015-09-03
Authors: Nancy Luo; Haolin Xu; Hani Jneid; Gregg C Fonarow; Renato D Lopes; Jonathan P Piccini; Anne B Curtis; Andrea M Russo; William R Lewis; Roland A Matsouaka; Christopher B Granger; Robert J Mentz; Sana M Al-Khatib Journal: Circ Heart Fail Date: 2018-10 Impact factor: 8.790
Authors: Hooman Kamel; Mitchell S V Elkind; Prashant D Bhave; Babak B Navi; Peter M Okin; Costantino Iadecola; Richard B Devereux; Matthew E Fink Journal: Stroke Date: 2013-04-30 Impact factor: 7.914
Authors: Heidi Lehtola; Juha Hartikainen; Päivi Hartikainen; Tuomas Kiviniemi; Ilpo Nuotio; Antti Palomäki; Antti Ylitalo; K E Juhani Airaksinen; Pirjo Mustonen Journal: Clin Cardiol Date: 2018-05-10 Impact factor: 2.882
Authors: Heidi Lehtola; Antti Palomäki; Pirjo Mustonen; Päivi Hartikainen; Tuomas Kiviniemi; Henri Sallinen; Ilpo Nuotio; Antti Ylitalo; K E Juhani Airaksinen; Juha Hartikainen Journal: Neurol Clin Pract Date: 2018-08
Authors: Hrvoje Budinčević; Petra Črnac Žuna; Christian Saleh; Nicholas Lange; Bartlomiej Piechowski-Jozwiak; Ivan Bielen; Vida Demarin Journal: Heliyon Date: 2020-01-27