1. Risk of Cerebrovascular Events in Intracerebral Hemorrhage Survivors With Atrial Fibrillation: A Nationwide Cohort Study
- Author
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Peter Brønnum Nielsen, Line Melgaard, Thure Filskov Overvad, Martin Jensen, Torben Bjerregaard Larsen, Gregory Y.H. Lip, Roland Veltkamp, Kirsten H Harvey, Eleni Korompoki, Lucio D’Anna, Omid Halse, Klemens Hügen, Uwe Malzahn, Sabine Ullmann, Carolin Schuhmann, Gabriele Putz Todd, Hannes Brinz, Peter U. Heuschmann, Kirsten Haas, Viktoria Rücker, Christian Enzinger, Stefan Ropele, Daniela Pinter, Melanie Haidegger, Thomas Gattringer, Simon Fandler-Höfler, Charles D. A. Wolfe, Yanzhong Wang, Hatem A. Wafa, Joan Montaner, Elena Palà, Stéphanie Debette, Igor Sibon, Pauline Renou, Morgane Lachaize, Léa Milan, Nathalie Heyvang, Sylvain Ledure, Pascale Michel, Mara Graziani, Laura Marchini, Valeria Caso, Solveigh Horstmann, Jan Purrucker, Peter Ringleb, Mariam Haffa, Torsten Hoppe-Tichy, Walter E. Haefeli, Hanna M. Seidling, Jürgen Burhenne, Kathrin I. Foerster, Deirdre A Lane, Elena Ivany, and Robyn Lotto
- Subjects
Stroke/etiology ,Male ,anticoagulants ,Cohort Studies ,Risk Factors ,Atrial Fibrillation ,ischemic stroke ,hemorrhagic stroke ,Humans ,atrial fibrillation ,cardiovascular diseases ,Survivors ,Aged ,Cerebral Hemorrhage ,Advanced and Specialized Nursing ,Aged, 80 and over ,Anticoagulants ,Cerebral Hemorrhage/complications ,nervous system diseases ,Stroke ,Anticoagulants/therapeutic use ,epidemiology ,Female ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,Atrial Fibrillation/complications - Abstract
Background: In patients with intracerebral hemorrhage (ICH) and prevalent atrial fibrillation (AF), the optimal stroke prevention strategy is unclear. We sought to estimate the risk of cerebrovascular events among ICH survivors with AF. Methods: We used the Danish Stroke Registry to identify patients with incident ICH and prevalent AF between 2003 and 2018. Key inclusion/exclusion criteria of the PRESTIGE-AF (Prevention of Stroke in Intracerebral hemorrhage Survivors With Atrial Fibrillation) trial were applied. Cumulative incidence of recurrent ICH, cerebrovascular ischemic event, and all-cause death were investigated after one year. Results: A total of 1885 patients (median age 80.0 years; 47.6% females) were included in the study. We observed 191 cerebrovascular events and 650 all-cause deaths, and more cerebrovascular ischemic events (N=63) than recurrent ICH events (N=40). Risks of recurrent ICH, cerebrovascular ischemic event, and all-cause death were 1.5%, 3.2%, and 30.3%, respectively, among patients not exposed to OAC during follow-up. The cumulative incidences were 2.8% for recurrent ICH, 3.2% for cerebrovascular ischemic events, and 22.0% for all-cause death among patients initiating/resuming OAC during follow-up. Conclusions: We observed a high risk of cerebrovascular ischemic events and a very high risk of all-cause death at one year after the incident ICH. The results of ongoing clinical trials are warranted to determine optimal stroke prevention treatment among ICH survivors with concomitant AF.
- Published
- 2022
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