6533b857fe1ef96bd12b3a8b
RESEARCH PRODUCT
Risk Factors for Intracerebral Hemorrhage in Patients With Atrial Fibrillation on Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention
Panagiotis HalvatsiotisGiuseppe RealeJennifer A. FronteraGiuseppe MartiniS. PegoraroLeonardo PantoniAristeidis H. KatsanosPiergiorgio LochnerDaniel StrbianGiorgia ZepponiValentina SaiaKaren L. FurieGiancarlo AgnelliElisa GiorliErica ScherLina PalaiodimouValentina ArnaoGiorgio SilvestrelliSimona MarcheselliLetizia RivaAndrea ZiniAngela RisitanoTiziana TassinariCarlo Emanuele SaggeseFrancesco PalmeriniErika SchirinziMichael E. ReznikMarina ManninoJukka PutaalaMaria KosmidouMichela GiustozziCesare PortaMaurizio PaciaroniMarina PadroniLoris PoliMaria Cristina VedovatiDanilo ToniManuel CappellariAlessandro RoccoAlessandro PezziniAshkan ShoamaneshStefano ForlivesiSerena MonacoRaffaele OrnelloSimona SaccoSilvia RosaShadi YaghiValeria TerrusoAndrea AlbertiFrancesco CoreaElena FerrariChristoph StretzMarialuisa ZeddeMonica AcciarresiCataldo D'amoreKateryna AntonenkoNemanja PopovicFrancesca GuideriEvangelos NtaisBoris DoroninLuca MasottiFilippo AngeliniGiovanni OrlandiLicia DentiNicola MumoliSotirios GiannopoulosElisabetta TosoMaria Giulia MosconiPaolo AridonAurelia ZauliGiuseppe MicieliAzmil H. Abdul-rahimLaura BrancaleoniMarina DiomediElisa GrifoniGeorgios TsivgoulisMaurizio AcampaMichele VentiWalter AgenoPietro CaliandroAlfonso CicconeIsabella CanaveroLaura FrancoGeorge NtaiosFabio BandiniVera VolodinaPierluigi BertoraDimitrios SagrisAntonio BaldiMichele RomoliHanne SallinenMichelangelo MancusoYuriy FlominRossana TassiValeria CasoMassimo Del SetteEnrico Maria LottiAntonio GasparroAlberto ChitiJesse DawsonBrian Mac GroryAlberto Rigatellisubject
MaleAdministration Oral030204 cardiovascular system & hematologySettore MED/110302 clinical medicine80 and overrisk factorsMedicineatrial fibrillationProspective StudiesAged 80 and overatrial fibrillation; cerebral hemorrhage; logistic models; risk factors; white matter; Administration Oral; Aged; Aged 80 and over; Antithrombins; Atrial Fibrillation; Case-Control Studies; Cerebral Hemorrhage; Female; Humans; Male; Middle Aged; Prospective Studies; Risk Factors; StrokeAtrial fibrillationMiddle AgedVitamin K antagonist3. Good healthStrokeAdministrationSettore MED/26 - NeurologiaFemaleCardiology and Cardiovascular Medicinewhite mattermedicine.drugOralmedicine.medical_specialtymedicine.drug_classSettore MED/26Lower riskAntithrombins03 medical and health sciencesInternal medicineHumanscardiovascular diseaseslogistic modelAgedAdvanced and Specialized NursingIntracerebral hemorrhagecerebral hemorrhagebusiness.industryWarfarinmedicine.diseaseClinical trialatrial fibrillation; cerebral hemorrhage; logistic models; risk factors; white matterCase-Control StudiesConcomitantHeart failureNeurology (clinical)businesslogistic models030217 neurology & neurosurgerydescription
Background and Purpose: Clinical trials on stroke prevention in patients with atrial fibrillation have consistently shown clinical benefit from either warfarin or non–vitamin K antagonist oral anticoagulants (NOACs). NOAC-treated patients have consistently reported to be at lower risk for intracerebral hemorrhage (ICH) than warfarin-treated patients. The aims of this prospective, multicenter, multinational, unmatched, case-control study were (1) to investigate for risk factors that could predict ICH occurring in patients with atrial fibrillation during NOAC treatment and (2) to evaluate the role of CHA 2 DS 2 -VASc and HAS-BLED scores in the same setting. Methods: Cases were consecutive patients with atrial fibrillation who had ICH during NOAC treatment. Controls were consecutive patients with atrial fibrillation who did not have ICH during NOAC treatment. As within the CHA 2 DS 2 -VASc and HAS-BLED scores there are some risk factors in common, several multivariable logistic regression models were performed to identify independent prespecified predictors for ICH events. Results: Four hundred nineteen cases (mean age, 78.8±8.1 years) and 1526 controls (mean age, 76.0±10.3 years) were included in the study. From the different models performed, independent predictors of ICH were increasing age, concomitant use of antiplatelet agents, active malignancy, high risk of fall, hyperlipidemia, low clearance of creatinine, peripheral artery disease, and white matter changes. Low doses of NOACs (given according to label or not) and congestive heart failure were inversely associated with the risk of ICH. HAS-BLED and CHA 2 DS 2 -VASc scores performed poorly in predicting ICH with areas under the curves of 0.496 (95% CI, 0.468–0.525) and 0.530 (95% CI, 0.500–0.560), respectively. Conclusions: Several risk factors were associated to ICH in patients treated with NOACs for stroke prevention but not HAS-BLED and CHA 2 DS 2 -VASc scores.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2021-04-01 | Stroke |