Which Risk Factors Are More Associated With Ischemic Stroke Than Intracerebral Hemorrhage in Patients With Atrial Fibrillation?
- 1 August 2012
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 43 (8), 2048-2054
- https://doi.org/10.1161/strokeaha.112.654145
Abstract
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.This publication has 32 references indexed in Scilit:
- A New Risk Scheme to Predict Warfarin-Associated Hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) StudyJournal of the American College of Cardiology, 2011
- Guidelines for the Primary Prevention of StrokeStroke, 2011
- Intracranial and fatal bleeding according to indication for long‐term oral anticoagulant therapyJournal of Thrombosis and Haemostasis, 2010
- New AnticoagulantsCirculation, 2010
- Effect of Age on Stroke Prevention Therapy in Patients With Atrial FibrillationStroke, 2009
- Impact of Proteinuria and Glomerular Filtration Rate on Risk of Thromboembolism in Atrial FibrillationCirculation, 2009
- Blood Pressure in Relation to the Incidence of Cerebral Infarction and Intracerebral HemorrhageStroke, 2007
- Clinical classification schemes for predicting hemorrhage: Results from the National Registry of Atrial Fibrillation (NRAF)American Heart Journal, 2006
- Major Risk Factors for Intracerebral Hemorrhage in the Young Are ModifiableStroke, 2005
- Blood pressure, haemorrhagic stroke, and ischaemic stroke: the Korean national prospective occupational cohort studyBMJ, 2004