Longer term stroke risk in intracerebral haemorrhage survivors

ObjectiveTo evaluate the influence of intracerebral haemorrhage (ICH) location on stroke outcomes.MethodsWe included patients recruited to a UK hospital-based, multicentre observational study of adults with imaging confirmed spontaneous ICH. The outcomes of interest were occurrence of a cerebral ischaemic event (either stroke or transient ischaemic attack) or a further ICH following study entry. Haematoma location was classified as lobar or non-lobar.ResultsAll 1094 patients recruited to the CROMIS-2 (Clinical Relevance of Microbleeds in Stroke) ICH study were included (mean age 73.3 years; 57.4% male). There were 45 recurrent ICH events (absolute event rate (AER) 1.88 per 100 patient-years); 35 in patients presenting with lobar ICH (n=447, AER 3.77 per 100 patient-years); and 9 in patients presenting with non-lobar ICH (n=580, AER 0.69 per 100 patient-years). Multivariable Cox regression found that lobar ICH was associated with ICH recurrence (HR 8.96, 95% CI 3.36 to 23.87, p<0.0001); similar results were found in multivariable completing risk analyses. There were 70 cerebral ischaemic events (AER 2.93 per 100 patient-years); 29 in patients presenting with lobar ICH (AER 3.12 per 100 patient-years); and 39 in patients with non-lobar ICH (AER 2.97 per 100 patient-years). Multivariable Cox regression found no association with ICH location (HR 1.13, 95% CI 0.66 to 1.92, p=0.659). Similar results were seen in completing risk analyses.ConclusionsIn ICH survivors, lobar ICH location was associated with a higher risk of recurrent ICH events than non-lobar ICH; ICH location did not influence risk of subsequent ischaemic events.Trial registration numberNCT02513316.

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Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study

BMJ ◽

10.1136/bmj.n453 ◽

2021 ◽

pp. n453

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Transient Ischaemic Attack ◽

Prospective Cohort ◽

Stroke Risk ◽

Ischaemic Attack

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Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study

BMJ ◽

10.1136/bmj.n49 ◽

2021 ◽

pp. n49

Author(s):

Jeffrey J Perry ◽

Marco L A Sivilotti ◽

Marcel Émond ◽

Ian G Stiell ◽

Grant Stotts ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Carotid Artery ◽

Confidence Interval ◽

Carotid Endarterectomy ◽

Likelihood Ratio ◽

Transient Ischaemic Attack ◽

Carotid Artery Stenting ◽

Stroke Risk ◽

Ischaemic Attack

Abstract Objective To validate the previously derived Canadian TIA Score to stratify subsequent stroke risk in a new cohort of emergency department patients with transient ischaemic attack. Design Prospective cohort study. Setting 13 Canadian emergency departments over five years. Participants 7607 consecutively enrolled adult patients attending the emergency department with transient ischaemic attack or minor stroke. Main outcome measures The primary outcome was subsequent stroke or carotid endarterectomy/carotid artery stenting within seven days. The secondary outcome was subsequent stroke within seven days (with or without carotid endarterectomy/carotid artery stenting). Telephone follow-up used the validated Questionnaire for Verifying Stroke Free Status at seven and 90 days. All outcomes were adjudicated by panels of three stroke experts, blinded to the index emergency department visit. Results Of the 7607 patients, 108 (1.4%) had a subsequent stroke within seven days, 83 (1.1%) had carotid endarterectomy/carotid artery stenting within seven days, and nine had both. The Canadian TIA Score stratified the risk of stroke, carotid endarterectomy/carotid artery stenting, or both within seven days as low (risk ≤0.5%; interval likelihood ratio 0.20, 95% confidence interval 0.09 to 0.44), medium (risk 2.3%; interval likelihood ratio 0.94, 0.85 to 1.04), and high (risk 5.9% interval likelihood ratio 2.56, 2.02 to 3.25) more accurately (area under the curve 0.70, 95% confidence interval 0.66 to 0.73) than did the ABCD2 (0.60, 0.55 to 0.64) or ABCD2i (0.64, 0.59 to 0.68). Results were similar for subsequent stroke regardless of carotid endarterectomy/carotid artery stenting within seven days. Conclusion The Canadian TIA Score stratifies patients’ seven day risk for stroke, with or without carotid endarterectomy/carotid artery stenting, and is now ready for clinical use. Incorporating this validated risk estimate into management plans should improve early decision making at the index emergency visit regarding benefits of hospital admission, timing of investigations, and prioritisation of specialist referral.

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Aspirin plus clopidogrel in acute minor ischaemic stroke or transient ischaemic attack is superior to aspirin alone for stroke risk reduction: CHANCE trial

Evidence-Based Medicine ◽

10.1136/eb-2013-101512 ◽

2013 ◽

Vol 19 (2) ◽

pp. 58-58 ◽

Cited By ~ 4

Author(s):

Philip B Gorelick ◽

Muhammad U Farooq

Keyword(s):

Ischaemic Stroke ◽

Risk Reduction ◽

Transient Ischaemic Attack ◽

Stroke Risk ◽

Ischaemic Attack

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Stroke risk prediction after transient ischaemic attack

The Lancet Neurology ◽

10.1016/s1474-4422(16)30248-4 ◽

2016 ◽

Vol 15 (12) ◽

pp. 1199-1200

Author(s):

Anthony S Kim

Keyword(s):

Risk Prediction ◽

Transient Ischaemic Attack ◽

Stroke Risk ◽

Ischaemic Attack

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Knowledge of Stroke Risk Factors and Warning Signs in Patients with Recurrent Stroke or Recurrent Transient Ischaemic Attack in Thailand

Neurology Research International ◽

10.1155/2017/8215726 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Jittima Saengsuwan ◽

Pathitta Suangpho ◽

Somsak Tiamkao

Keyword(s):

Risk Factors ◽

Transient Ischaemic Attack ◽

Stroke Risk ◽

Recurrent Stroke ◽

Warning Signs ◽

High Risk Population ◽

Cross Sectional ◽

Stroke Risk Factors ◽

Ischaemic Attack ◽

Structured Interventions

Stroke is a global burden. It is not known whether patients who are most at risk of stroke (recurrent stroke or recurrent transient ischaemic attack) have enough knowledge of stroke risk factors and warning signs. The aim of this study was to assess the knowledge of stroke risk factors and warning signs in this high-risk population. We performed a cross-sectional questionnaire-based study of patients with recurrent stroke or recurrent TIA admitted to Srinagarind Hospital and Khon Kaen Hospital, Thailand. A total of 140 patients were included in the study (age 65.6±11.3 years [mean ± SD], 62 females). Using an open-ended questionnaire, nearly one-third of patients (31.4%) could not name any risk factors for stroke. The most commonly recognized risk factors were hypertension (35%), dyslipidemia (28.6%), and diabetes (22.9%). Regarding stroke warning signs, the most commonly recognized warning signs were sudden unilateral weakness (61.4%), sudden trouble with speaking (25.7%), and sudden trouble with walking, loss of balance, or dizziness (21.4%). Nineteen patients (13.6%) could not identify any warning signs. The results showed that knowledge of stroke obtained from open-ended questionnaires is still unsatisfactory. The healthcare provider should provide structured interventions to increase knowledge and awareness of stroke in these patients.

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