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Intracerebral haemorrhage carries elevated short-term risk of ischaemic stroke in elderly

20 Dec 2019

Elderly patients with intracerebral haemorrhage (ICH) are at high risk of ischaemic stroke in the first 6 months following diagnosis, a study has found.

Researchers used claims data from 1,760,439 Medicare beneficiaries, among whom 5,924 had ICH. Patients with vs without ICH were older (mean, 79.4 vs 73.5 years) and more likely to have hypertension, coronary artery disease, atrial fibrillation and valvular heart disease.

The primary outcome of a composite of acute ischaemic stroke and myocardial infarction (MI) were diagnosed in 137,912 patients (7.8 percent) in the cohort. The 1-year cumulative incidence of an arterial ischaemic event was 5.7 percent (95 percent confidence interval [CI], 4.8–6.8) in the ICH group and 1.8 percent (95 percent CI, 1.7–1.9) in the non-ICH group.

Multivariable Cox models showed that the risk of an arterial ischaemic event was pronounced in the first month after ICH diagnosis (hazard ratio [HR], 6.7, 95 percent CI, 5.0–8.6) and remained significantly increased for the first 6 months.

In a separate analysis of stroke and MI, ICH was associated with an increased risk of ischaemic stroke in the first 6 months after diagnosis (HR, 6.1, 95 percent CI, 3.5–9.3). This was not true for the risk of MI (HR, 1.6, 95 percent CI, 0.3–2.9).

In sensitivity analyses excluding patients with atrial fibrillation and valvular heart disease, the association between ICH and arterial ischaemic events was similar to that observed in the primary analysis.

The results suggest that elderly patients with ICH have a substantially increased risk of ischaemic stroke in the first 6 months after diagnosis, the researchers said, underscoring a need for further exploration to determine optimal secondary prevention strategies in this population.

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Most Read Articles
Pearl Toh, 31 Dec 2019
Adding the neuraminidase inhibitor oseltamivir to usual care speeds up recovery from influenza-like illness by a day compared with usual care alone, with even greater benefits seen in older, sicker patients with comorbidities, according to the ALIC4E study.
23 Dec 2019
At a Menarini-sponsored symposium held during the Asian Pacific Society Congress, renowned cardiologist Prof John Camm provided the latest evidence for chronic stable angina with or without concomitant diseases, with a special focus on the antianginal agent ranolazine and combination therapies. The event was chaired and moderated by Dr Dante Morales from the University of the Philippines College of Medicine.
Pearl Toh, 6 days ago
Obeticholic acid significantly improves fibrosis and disease activity in patients with nonalcoholic steatohepatitis (NASH), a chronic liver disease currently with no approved therapy, according to an interim analysis of the landmark REGENERATE* study.
12 Jan 2020
Testosterone treatment may slightly improve sexual functioning and quality of life in men without underlying organic causes of hypogonadism, but it offers little to no benefit for other common symptoms of ageing, according to a study. In addition, long-term efficacy and safety of this therapy remain unknown.