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. 2022 Aug;53(8):2559-2568.
doi: 10.1161/STROKEAHA.121.038331. Epub 2022 Apr 13.

Risk of Cerebrovascular Events in Intracerebral Hemorrhage Survivors With Atrial Fibrillation: A Nationwide Cohort Study

Peter Brønnum Nielsen  1   2 , Line Melgaard  1   2 , Thure Filskov Overvad  3 , Martin Jensen  1 , Torben Bjerregaard Larsen  1   2 , Gregory Y H Lip  2   4 ; PRESTIGE-AF Consortium
Collaborators, Affiliations

Risk of Cerebrovascular Events in Intracerebral Hemorrhage Survivors With Atrial Fibrillation: A Nationwide Cohort Study

Peter Brønnum Nielsen et al. Stroke. 2022 Aug.

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.

Keywords: anticoagulants; atrial fibrillation; epidemiology; hemorrhagic stroke; ischemic stroke.

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Figures

Figure 1.
Figure 1.
Flowchart of the study population. All patients were aged ≥18 y.
Figure 2.
Figure 2.
Cumulative incidence of recurrent intracerebral hemorrhage (ICH), cerebrovascular ischemic event, and all-cause death after 1 y of follow-up according to the baseline CHA2DS2-VASc score category.
See this image and copyright information in PMC

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