Intracerebral hemorrhage: who gets tested for methamphetamine use and why might it matter?

Abstract Background Methamphetamine use is an emerging risk factor for intracerebral hemorrhage (ICH). The aim of this study was to investigate the use of urine drug screen (UDS) for identifying methamphetamine-associated ICH. Methods This is a retrospective, single-center study of consecutive patients hospitalized with spontaneous ICH from January 2013 to December 2017. Patients were divided into groups based on presence of UDS. The characteristics of patients with and without UDS were compared. Factors associated with getting UDS were explored using multivariable analyses. Results Five hundred ninety-six patients with ICH were included. UDS was performed in 357 (60%), and positive for methamphetamine in 44 (12.3%). In contrast, only 19 of the 357 patients (5.3%) had a documented history of methamphetamine use. Multivariable analysis demonstrated that patients screened with UDS were more likely to be younger than 45 (OR, 2.24; 95% CI, 0.26–0.78; p = 0.004), male (OR, 1.65; 95% CI, 0.44–0.84; p = 0.003), smokers (OR, 1.74; 95% CI, 1.09–2.77; p < 0.001), with history of methamphetamine use (OR, 10.48; 95% CI, 2.48–44.34; p < 0.001), without diabetes (OR 1.47; 95% CI, 0.471–0.975; p = 0.036), not on anticoagulant (OR, 2.20; 95% CI, 0.26–0.78; p = 0.004), with National Institutes of Health Stroke Scale (NIHSS) > 4 (OR, 1.92; 95%CI, 1.34–2.75; p < 0.001), or require external ventricular drain (EVD) (OR, 1.63; 95%CI, 1.07–2.47; p = 0.021. There was no significant difference in race (p = 0.319). Reported history of methamphetamine use was the strongest predictor of obtaining a UDS (OR,10.48). Five percent of patients without UDS admitted history of use. Conclusion UDS identified 12.3% of ICH patients with methamphetamine use as compared to 5.3% per documented history of drug use. There was no racial bias in ordering UDS. However, it was more often ordered in younger, male, smokers, with history of methamphetamine use, without diabetes or anticoagulant use.

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Abstract P256: Association Between Antidepressants Use and Intracerebral Hemorrhage: Florida Stroke Registry

Stroke ◽

10.1161/str.52.suppl_1.p256 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Mithilesh Siddu ◽

Antonio Bustillo ◽

Carolina M Gutierrez ◽

Kefeng Wang ◽

Hannah Gardener ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Oral Anticoagulants ◽

Large Population ◽

Multivariable Analysis ◽

Population Based ◽

Prior History ◽

Stroke Registry ◽

The Us ◽

History Of ◽

Antidepressant Use

Introduction: SSRIs, the most commonly prescribed antidepressants (AD) in the US, are linked to an increased intracerebral hemorrhage (ICH) risk possibly related to impaired platelet function. In the Florida Stroke Registry (FSR), we studied the proportion of cases presenting with ICH amongst AD users and the rate of SSRI prescription amongst stroke patients discharged on AD. Methods: From Jan 2010 to Dec 2019 we included 127,915 cases from FSR in whom information on AD use was available. Multivariable logistic regression was used to evaluate ICH proportions amongst AD and non-AD users and rates of prescribed SSRIs at discharge. Results: The rate of ICH amongst prior AD users (n=17,009, median age 74, IQR=19) and non-AD users (n=110,906, median age 72, IQR=21) were 11% and 14% respectively. Prior AD users were more likely to be female (17% vs. 10% male), non-Hispanic White (16% vs. 8% non-Hispanic Black vs. 12% Florida Hispanic vs. 6% Puerto Rican Hispanic), have hypertension (HTN) (14.% vs. 10%), diabetes mellitus (DM) (16% vs.12%), use oral anticoagulants (OAC) (17 % vs. 13%), antiplatelets (AP; 17% vs. 11%), and statins (17% vs. 10%) prior to hospital presentation. In multivariable analysis adjusting for age, race, prior history of HTN, DM, prior OAC, AP and statin use, AD users just as likely to present with spontaneous ICH as compared to non-AD users (OR=0.92, 95% CI 0.85, 1.01). A total of 3.4% of all ICH patients and 9% of those in whom AD information was available were discharged home on an AD (74 % SSRI, 24% other AD). Conclusion: In this large population-based study, we did not find an association between prior AD use and an increased rate of ICH. Importantly AD (mostly SSRIs) are commonly prescribed to patients with ICH in routine clinical practice. The association between types, duration, and safety of antidepressant use in ICH patients deserves further studies.

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To Explore the Association Between Coagulation Function and Cerebral Microbleeds in Patients With Intracerebral Hemorrhage

10.21203/rs.3.rs-266084/v1 ◽

2021 ◽

Author(s):

Zhenhua Wang ◽

Xinlan Xiao

Keyword(s):

Risk Factors ◽

Intracerebral Hemorrhage ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

International Normalized Ratio ◽

Cerebral Microbleeds ◽

Baseline Characteristic ◽

Coagulation Function ◽

Significant Difference ◽

History Of

Abstract Object:To verify the association between coagulation function and cerebral microbleeds(CMBs) in patients with intracerebral hemorrhage(ICH).Methods: A total of 193 patients underwent 3.0T magnetic resonance image(MRI) and were found ICH,they were divided into CMBs and non-CMBs groups. Indicators of coagulation function and some other flood and clinical data like prothrombin time (PT), activated partial thromboplastin time(APTT), international normalized ratio (INR) were enrolled.univariate and multivariate analysis were used to compare the difference between the two groups and screen risk factors. One or more receiver operating characteristic(ROC) curve were used to present the predictive value of the indicators for CMBs.Result: After a univariate analysis, the result showed that INR levels was significantly higher in the CMBs group than the non-CMBs group [1.06 (0.96, 1.12) vs. 0.97 (0.93, 1.03);P= 0.035), while there was no significant difference between PT, APTT, TT and FBI. To compare the baseline characteristic of the two groups showed that the age ,the proportion of a history of long-term antithrombotic treatment(AT), history of ischemic stroke(IS) and combination with a brain atrophy(BA) cases in the CMBs group was significantly higher than the non-CMBs group(each P < 0.05). Multivariate logistic regression analysis showed that age and IS were independent risk factors for CMBs in patients with ICH (OR:0.967, 95% CI: 0.936-0.998, P = 0.036; OR:2.016, 95% CI: 1.090-3.991,P = 0.044; respectively). ROC curves indicated that the area under curve(AUC) of age and IS for CMBs in patients with ICH was 0.610(95%CI:51.76%-70.32%) and 0.619(95%CI:53.32%-68.87%), respectively.Conclusion:Age and IS were the independent risk factor for CMBs in patients with ICH, among the coagulant indicators, INR showed a significantly higher level in the CMBs group than the non-CMBs group.

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ASXL1/SRSF2 Co-Mutated Acute Myeloid Leukemia (AML): A Rare but Distinct Subpopulation with Dismal Outcomes

Blood ◽

10.1182/blood-2019-122929 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 2598-2598

Author(s):

Daniel R. Richardson ◽

David M Swoboda ◽

Anastasia Ivanova ◽

Steven M Johnson ◽

Jonathan Galeotti ◽

...

Keyword(s):

Research Funding ◽

Multivariable Analysis ◽

Prior History ◽

Treatment Intensity ◽

Cell Transplant ◽

Myeloid Neoplasm ◽

Significant Difference ◽

History Of ◽

Baseline Characteristics

Background: Advances in the understanding of the genetic determinants of AML and the widespread use of next-generation sequencing (NGS) have led to the refinement of prognostically distinct molecular subgroups. Mutations in ASXL1 and SRSF2, which are common in myelodysplastic syndrome (MDS) and myeloproliferative neoplasms (MPNs), rarely co-occur in patients (pts) with AML. The largest reported cohort (n=15) of ASXL1/SRSF2 co-mutated AML had no long-term survivors (Papaemmanuil et al. NEJM 2016). It remains unknown how clinical factors such as prior history of a myeloid neoplasm or intensity of treatment influence outcomes. We sought to assess the clinical characteristics and analyze outcomes in a larger cohort of pts with ASXL1/SRSF2 co-mutated AML. We hypothesized that this profile may be a genomic footprint of prior myeloid neoplasia. Methods: We conducted a multi-institutional retrospective analysis of newly diagnosed adult AML pts with both ASXL1 and SRSF2 mutations at the University of North Carolina and at Moffitt Cancer Center from 2011-2018. NGS was performed on DNA using the Illumina TruSight Myeloid 54-gene sequencing panel. The primary endpoint was overall survival (OS) defined as time from diagnosis of AML to death. Pts were stratified by secondary AML (s-AML), defined as having a documented history of MDS/MPN. Secondary outcomes included rates of complete remission (CR) and CR with incomplete hematologic recovery (CRi). Multivariable analysis was performed with baseline characteristics. Results: Forty-six pts were identified and included. The median age of pts was 72 years (range 42 - 85). Sixty-seven percent (28/42) had normal cytogenetics; 88% (37/42) were intermediate risk cytogenetics by current ELN guidelines. Sixty-one percent (n=28) were classified as having s-AML. One pt had therapy-related AML without preexisting MDS/MPN and was therefore not included in s-AML. The Figure illustrates co-existing mutations and individual responses to upfront therapy stratified by s-AML and non-s-AML. The median number of mutations was 5 (range 2 - 7). The most common co-occurring mutations were TET2 (52%), RUNX1 (35%), IDH2 (15%), and STAG2 (15%). Median OS was 7.0 months (m) (CI 5.3, 15.4). Median OS for pts with s-AML (n=28) and non-s-AML (n=18) was 6.1 and 15.4 m (p=0.05), respectively. There was no significant difference in median OS between s-AML and non-s-AML on multivariable analysis (hazard ratio (HR) = 2.56, p=0.07). Median OS did not differ by age (Age <65 years v. older, p=0.54), total # of mutations (≥ 5 v. less, p=0.73), or etiology of s-AML (MDS v. MPN, p=0.66). Twenty-two (47%) pts received upfront intensive induction chemotherapy (IC), 17 (37%) received hypomethylating agents (HMAs), and 7 pts (15%) received no AML-directed chemotherapy. Median OS did not significantly differ between pts receiving upfront IC and HMAs (15.3 v. 7.04 m, p=0.21). Among non-s-AML pts, median OS was longer in those receiving IC (n=10) versus HMAs (n=7) (15.4 v. 3.5 m, p=0.01). Among all pts receiving IC, median OS was longer in non-s-AML pts (n=10) versus s-AML pts (n=12) (15.4 v. 5.9 m, p=0.01). Median OS did not differ by treatment intensity for s-AML pts (IC v. HMA: 5.9 v. 9.9 m, p=0.38). Six pts underwent allogeneic hematopoietic cell transplant (HCT) with a median OS NR (median follow-up 15.6 m). Overall rate of CR/CRi was 35% and was similar between pts receiving IC and HMAs (45% v. 21%, p=0.29). Among pts with non-s-AML, CR/CRi rates with IC and HMAs were 70% and 29%, respectively (p=0.11). Among pts with s-AML, CR/CRi rates with IC and HMAs were 42% and 20%, respectively (p=0.38). On multivariable analysis of baseline characteristics, only ECOG performance status (PS) was significantly associated with OS (HR 2.25, p=0.01). ECOG PS remained significant (HR 2.65, p=0.03) after adjusting for HCT and treatment intensity. Conclusions: ASXL1/SRSF2 co-mutated AML represents a rare but distinct genotype with most pts having pre-existing myeloid neoplasms and associated co-mutations commonly seen in MDS/MPNs. OS is dismal regardless of age, number of mutations, treatment intensity, or prior history of myeloid neoplasm. HCT may mitigate these poor outcomes and lead to long-term survival. This represents the largest reported cohort to date of pts with ASXL1/SRSF2 co-mutated AML. Further study is warranted to inform risk stratification and prognosis of pts with ASXL1/SRSF2-mutated AML. Disclosures Foster: Bellicum Pharmaceuticals, Inc: Research Funding; Daiichi Sankyo: Consultancy; MacroGenics: Research Funding; Celgene: Research Funding. Coombs:Octopharma: Honoraria; Pharmacyclics: Honoraria; Medscape: Honoraria; Abbvie: Consultancy; Loxo: Honoraria; Cowen & Co.: Consultancy; Dedham Group: Consultancy; H3 Biomedicine: Honoraria; Covance: Consultancy. Sallman:Celyad: Membership on an entity's Board of Directors or advisory committees. Zeidner:Agios: Honoraria; Celgene: Consultancy, Honoraria, Research Funding; Daiichi Sankyo: Honoraria; Tolero: Honoraria, Research Funding; Pfizer: Honoraria; AsystBio Laboratories: Consultancy; Merck: Research Funding; Takeda: Research Funding; AbbVie: Honoraria.

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Prognostic Impact of Sarcopenia and Radiotherapy in Patients With Advanced Gastric Cancer Treated With Anti-PD-1 Antibody

Frontiers in Immunology ◽

10.3389/fimmu.2021.701668 ◽

2021 ◽

Vol 12 ◽

Author(s):

Nalee Kim ◽

Jeong Il Yu ◽

Do Hoon Lim ◽

Jeeyun Lee ◽

Seung Tae Kim ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Negative Impact ◽

Multivariable Analysis ◽

Immune Checkpoint Blockade ◽

Prognostic Impact ◽

Skeletal Muscle Index ◽

Entire Cohort ◽

Significant Difference ◽

History Of

BackgroundWe explored the combined effects of sarcopenia (SAR) and radiotherapy (RT) on outcomes in patients with advanced gastric cancer (AGC) treated with immune-checkpoint blockade (ICB).MethodsAmong 185 patients with AGC treated with ICB, we defined SAR as skeletal muscle index <49 cm2/m2 for men and <31 cm2/m2 for women; 93 patients met criteria. We defined high neutrophil-to-lymphocyte ratio (hNLR) as NLR≥3. Palliative RT was performed in 37 patients (20%) before ICB.ResultsWe frequently observed hNLR in patients with SAR (53% vs. 35%, p = 0.02). The median overall survival (OS) for the entire cohort was 5 months. Stratification by risk factors of SAR or hNLR revealed a significant difference in median OS (0 [N = 60] vs. 1 [N = 76] vs. 2 [N = 49]: 7.6 vs. 6.4 vs. 2.2 months, p < 0.001). Patients with microsatellite instability-high (MSI-H, N = 19) or Epstein-Barr virus (EBV)-positive tumors (N = 13) showed favorable outcomes compared to those with microsatellite stable (MSS, N = 142) tumors (median OS, not reached vs. 16.8 vs. 3.8 months, respectively). The benefit of RT was evident in patients with both SAR and hNLR (median OS, 3.1 vs. 1.3 months, p = 0.02) and MSS/EBV-negative tumor (median OS, 6.5 vs. 3.5 months, p = 0.03), but outcomes after RT in MSI-H tumor were not significantly different. In multivariable analysis, SAR/hNLR, molecular subtypes, and a history of RT were associated with OS (all p < 0.05).ConclusionsWe demonstrated the negative predictive value of SAR/hNLR on outcomes after ICB for AGC, and the history of RT could overcome the negative impact of SAR/hNLR and the MSS/EBV-negative subtype.

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Abstract TP376: Infections in Patients With Spontaneous Intraventricular Hemorrhage- Results From the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage (CLEAR) III Trial

Stroke ◽

10.1161/str.47.suppl_1.tp376 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Jharna N Shah ◽

Santosh B Murthy ◽

Nichol McBee ◽

Rachel Dlugash ◽

Malathi Ram ◽

...

Keyword(s):

Length Of Stay ◽

Intracerebral Hemorrhage ◽

Outcome Measures ◽

Intraventricular Hemorrhage ◽

External Ventricular Drain ◽

Randomized Study ◽

Multivariable Analysis ◽

Hospital Length Of Stay ◽

Secondary Outcome ◽

Clot Lysis

Introduction: Intraventricular hemorrhage (IVH) occurs in about 40% of patients with intracerebral hemorrhage (ICH) and is associated with higher mortality and worse outcomes than ICH patients without IVH. Infections are common in ICH patients but data in IVH patients are limited. Methods: Prospective analysis of adjudicated adverse event infection reporting during first 180 days in 500 patients enrolled in the CLEAR III trial, a multicenter, double-blind, randomized study comparing external ventricular drain (EVD) + intraventricular recombinant tissue plasminogen activator (rtPA) vs. EVD + placebo for treatment of obstructive IVH and intracerebral hemorrhage (ICH) volume <30cc. Primary outcome measures were 90-day and 180-day mortality. Secondary outcome measures were hospital length of stay (LOS). We constructed binary logistic and linear regression models for multivariable analysis. Results: Infection was reported in 269 patients (53.8%). Pneumonia was the most common infection (33%), followed by UTI (16%), and bacterial ventriculitis (4.4%). Overall 180-day mortality was 20%. Patients with infection were more likely to have older age (p=0.012), lower admission GCS (p=0.007), higher ICH volume (8.8 vs 6.7ml, p=0.001), and higher ICH+IVH volume (37.7 vs 31.7 ml, p=0.002). In the regression model, IVH volume was associated with higher odds of 90-day or 180-day mortality, but presence of any infection was not a significant predictor of mortality. Infection was however associated with longer length of stay (26 vs 22 days, p<0.001). Subgroup analysis of individual infections, showed only bacterial ventriculitis to be associated with 90-day (OR: 3.84, CI: 1.36-10.82), and 180-day mortality (OR: 2.9, CI: 1.05-8.06), while pneumonia and UTI were not. Conclusion: Patients with IVH have a high incidence of infections, which is associated with longer hospitalization but does not appear to influence mortality. Of the infections, bacterial ventriculitis is a significant predictor of mortality in our 7-factor model. IVH volume did not predict infections but predicted mortality.These results form a basis for future correlation of infectious complications with treatment rendered (thrombolysis versus placebo), with upcoming unblinding of the trial.

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Abstract P415: Is Hemostatic Efficacy of Four Factor Prothrombin Complex Concentrate Similar in Intracerebral Hemorrhage Patients Receiving Warfarin vs Non-Vitamin K Anticoagulants?

Stroke ◽

10.1161/str.52.suppl_1.p415 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Gregory Pon ◽

Brittany Pelsue ◽

Xu Zhang ◽

Brian Gulbis ◽

Sujan T Reddy ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Vitamin K ◽

Prothrombin Complex Concentrate ◽

Multivariable Analysis ◽

Chi Square ◽

Significant Difference ◽

Forward Stepwise ◽

Multivariable Regression ◽

Baseline Characteristics ◽

Hemostatic Efficacy

Introduction: Four Factor Prothrombin Complex Concentrate (4F-PCC) is indicated for reversal of warfarin-induced coagulopathy. In small cohort studies, 4F-PCC has similar hemostatic efficacy rates reversing non-vitamin K anticoagulants (NOACs). There are no comparison studies evaluating 4F-PCC for the reversal of warfarin versus NOACs in the setting of intracerebral hemorrhage (ICH). Methods: A multicenter retrospective cohort study was conducted between 2013-2020 at a comprehensive stroke system in ICH patients who received 4F-PCC for the reversal of warfarin or a NOAC. Patients were included if they were adults with an acute ICH, anticoagulant regimen of warfarin (INR 1.3 or greater) or NOAC, and 2 head CT scans within 24 hours to determine hemostatic efficacy. Hemostatic efficacy was evaluated by the Sarode scale. The chi square and t-test were used as appropriate for demographic and clinical data, with multivariable regression analysis conducted in a forward stepwise manner, retaining variables with significance less than 0.05. Results: One hundred fifty-seven patients were included (baseline characteristics in Table 1). There was no statistically significant difference in effective hemostasis observed between warfarin and NOAC patients (83% vs 75%, p=0.33). Similarly, multivariable analysis did not demonstrate a significant difference in effective hemostasis (OR 0.55, 95% CI: 0.2-1.3, p=0.2). However, due to wide 95% confidence intervals, we cannot exclude a key treatment effect from PCC. After controlling for baseline characteristics, patients treated with NOACs had 53% lower odds of a good clinical outcome compared to those treated with warfarin (Figure 1; OR 0.47, 95% CI: 0.2-1.3, p=0.13). Conclusions: In conclusion, there was no statistically significant difference in hemostatic efficacy or clinical outcomes between warfarin and NOAC patients following reversal with 4F-PCC.

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Influence of the Extent of Intraventricular Hemorrhage on Functional Outcome and Mortality in Intracerebral Hemorrhage

Cerebrovascular Diseases ◽

10.1159/000501027 ◽

2019 ◽

Vol 47 (5-6) ◽

pp. 245-252 ◽

Cited By ~ 5

Author(s):

Sebastian S. Roeder ◽

Maximilian I. Sprügel ◽

Jochen A. Sembill ◽

Antje Giede-Jeppe ◽

Kosmas Macha ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Intraventricular Hemorrhage ◽

Obstructive Hydrocephalus ◽

External Ventricular Drain ◽

Multivariable Analysis ◽

Unfavorable Outcome ◽

Unfavorable Clinical Outcome ◽

Multivariable Analyses ◽

The Impact

Background and Objective: Intraventricular hemorrhage (IVH) is a verified independent prognostic parameter in patients with intracerebral hemorrhage (ICH). However, the impact of the extent of IVH on clinical outcomes is unestablished. Methods: We analyzed 1,112 consecutive primary ICH patients of the UKER-ICH cohort (NCT03183167) and hypothesized that there is no difference in outcome between patients without IVH and patients with minor IVH not leading to obstructive hydrocephalus. Propensity score matching and multivariable analyses were performed to account for imbalances in baseline characteristics. Primary outcome was defined as functional outcome 3 months after ICH assessed using the modified Rankin Scale (mRS) dichotomized into favorable (mRS = 0–3) and unfavorable outcome (mRS = 4–6). Secondary outcomes included mortality at 3 months and a Graeb score-based threshold analysis for association of the extent of IVH with unfavorable clinical outcome. Results: Among the 461 out of 1,112 (41.5%) ICH patients with IVH, 191 out of 461 (41.4%) showed IVH without obstructive hydrocephalus and no requirement of external ventricular drain (EVD) placement. After adjusting for baseline imbalances we found no difference in functional outcome at 3 months between patients without IVH (No-IVH) and patients with IVH not requiring EVD (IVH-w/o-EVD): mRS 0–3: No-IVH 64/161 (39.8%) vs. IVH-w/o-EVD 53/170 (31.2%); p = 0.103. However, there was a trend toward a higher mortality in IVH-w/o-EVD patients (mRS 6: No IVH 40/161 [24.8%] vs. IVH-w/o-EVD 57/170 [33.5%]; p = 0.083). Multivariable analysis revealed that a Graeb score >2 was independently associated with unfavorable outcome (mRS 4–6: OR 3.16 [1.54–6.48]; p = 0.002), and higher mortality (mRS 6: OR 2.57 [1.40–4.74]; p = 0.002) in IVH patients. Conclusions: Small amounts of intraventricular blood (Graeb score ≤2) not leading to obstructive hydrocephalus are not associated with unfavorable outcome or death after ICH. Thus, IVH per se should not be considered a binary variable in outcome prediction for ICH patients.

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Sinovenous Abnormalities in Patients of Idiopathic Intracranial Hypertension

TAJ Journal of Teachers Association ◽

10.3329/taj.v26i0.37588 ◽

2018 ◽

Vol 26 ◽

pp. 53-56

Author(s):

M Pervez Amin ◽

Pijush Kumar Kundu ◽

M Munzur Alahi ◽

Mukul Kumar Sarkar ◽

M Ahmed Ali ◽

...

Keyword(s):

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Transverse Sinus ◽

College Hospital ◽

Medical College ◽

Significant Difference ◽

History Of ◽

History Of Use ◽

The Brain

Idiopathic Intracranial Hypertension is a disease of unknown aetiology common in obese females and presents with headache, papilledema, raised CSF opening pressure, no abnormalities in CSF examination and no abnormality on CT scan or MRI of the Brain. Sinovenous abnormalities are commonly detected in patients of IIH by different neuroimaging techniques. But the exact role of these sinovenous abnormalities in the causation of the disease or whether they are an effect of the disease is not yet known. Nor has a ‘gold standard’ investigation been established yet for detection of the sinovenous abnormalities. This study was done to detect the presence of sinovenous abnormalities in IIH patients by performing a Magnetic Resonance Venography of the brain. All 33 patients of IIH who presented to Rajshahi Medical College Hospital during the study period from June 2009 to May 2010 were included in the study. There were 30 females and 3 males having a F:M ratio of 10:1. 91% of the patients were between 20 and 35 years of age and most of them were married housewives. 63.64% patients had history of use of oral contraceptives. Unusually 51.52% of the patients had a BMI less than 25 indicating that they were not even overweight (BMI 25 to 30). Only 6% of the patients had BMI > 30 indicating that they were obese. Headache and papilloedema were present in all patients but visual difficulties were present only in 54.54% of the patients. Abnormalities in MRV of the brain were detected in 27.27% (9/33) of the patients and transverse sinus hypoplasia was the commonest finding (88.89% - 8/9 patients). There was no statistically significant difference in the findings of MRV abnormalities between the males and females or among the patients having BMI less or more than 25TAJ 2013; 26: 53-56

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Abstract WP368: The Association of Prior Use of Antiplatelet Agents and Increased Mortality and Morbidity in Intracerebral Hemorrhage Patients

Stroke ◽

10.1161/str.48.suppl_1.wp368 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Nadeem Khan ◽

Fazeel Siddiqui ◽

Joshua Goldstein ◽

Ying Xian ◽

Margueritte Cox ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Hospital Mortality ◽

Antiplatelet Therapy ◽

Antiplatelet Agents ◽

Mortality And Morbidity ◽

Significant Difference ◽

Prior Use ◽

History Of ◽

Artery Disease ◽

Ischemic Attack

Introduction: Use of anti-platelet therapy is common among patients presenting with intracerebral hemorrhage (ICH). There are limited data regarding pre-stroke antiplatelet therapy (APT) and outcomes in patients presenting with spontaneous ICH. We hypothesized that prior use of antiplatelet agents increases mortality and discharge morbidity in ICH patients. Methods: We analyzed data of 82,576 ICH patients not on anticoagulation from 2185 GWTG-Stroke hospitals between Oct 2012 and March 2016. Patients were categorized as no APT, single antiplatelet therapy (SAPT) and dual antiplatelet therapy (DAPT). Logistic regression using generalized estimating equations to account for within-site correlations were used to assess the relationship between outcomes and prior-APT use. Results: No pre-ICH APT was used in 65.8%, SAPT in 29.5%, and DAPT in 4.8%. The median age of the cohort was 69 years and prevalence of females in the cohort was 48.6%, with preponderance of white race (58.9%). Overall onset of symptoms to arrival time was 131 minutes with a median NIHSS of 9. A total of 23.7% had history of previous stroke/transient ischemic attack, 15.3% had prior myocardial infarction/coronary artery disease and 73.4% had known hypertension. There was no significant difference in in-hospital mortality among patients not on any APT vs patients on SAPT. However, in-hospital mortality was higher among ICH patients on DAPT compared with no therapy (adjusted OR 1.41, 95 % CI 1.31-1.51, P<0.0001). Conclusion: Our study suggests that patients on DAPT, but not on SAPT, have higher mortality rates after ICH compared with patients on no APT.

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Abstract 2733: The Comparative Importance of `Shared' Risk Factors for Ischemic Stroke and Intracerebral Hemorrhage in Patients with Atrial Fibrillation

Stroke ◽

10.1161/str.43.suppl_1.a2733 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Emer R McGrath ◽

Moira K Kapral ◽

Jiming Fang ◽

Martin J O'Donnell ◽

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Renal Impairment ◽

Intracerebral Hemorrhage ◽

Vascular Disease ◽

Multivariable Analysis ◽

Increased Risk ◽

History Of ◽

Shared Risk

Background: Optimal prescribing of oral anticoagulants, for the prevention of stroke in patients with atrial fibrillation, requires clinicians to estimate the competing risk of ischemic stroke and intracerebral hemorrhage (ICH). However, a number of risk factors increase the risk of both ischemic stroke and ICH (e.g. age, hypertension and chronic renal disease), and it is unclear how these ‘shared’ risk factors should influence decisions on antithrombotic therapy. Objective: To determine the comparative importance of risk factors for ischemic stroke and ICH in patients with atrial fibrillation, focusing primarily on risk factors included in the CHA2DS2VASC (risk of ischemic stroke) and HAS-BLED (risk of major bleeding) scores. Methods: Prospective registry of 3,197 patients admitted with acute ischemic stroke or ICH and atrial fibrillation included in the Registry of the Canadian Stroke Network (Jul 03-Mar 08; 11 Regional Stroke Centers in Ontario, Canada). Multivariable analysis was used to determine the association between baseline risk factors (age, sex, history of hypertension, previous stroke or transient ischemic attack, history of congestive heart failure, history of vascular disease, hepatic impairment, current alcohol intake, history of diabetes mellitus, history of gastro-intestinal bleeding, renal impairment, admission INR and antiplatelet therapy) and risk of ischemic stroke versus ICH. Results: Of 3,197 patients with atrial fibrillation and acute stroke, 2,806 (87.8%) presented with an ischemic stroke and 391 (12.2%) presented with an ICH. Of the ‘shared’ risk factors, age (OR 1.17; 95% CI 1.04-1.31 per decade) and previous history of stroke (OR 1.40; 95% CI 1.09-1.81) were associated with an increased risk of ischemic stroke relative to ICH, while a history of hypertension (OR 0.90; 95% CI 0.69-1.18) and renal impairment (OR 1.29; 0.96-1.72) were not associated with either stroke subtype, on multivariable analyses. Of the ‘non-shared’ risk factors, alcohol consumption of <2 units/day vs. no consumption (OR 1.61; 95% CI 1.24-2.09), female sex (OR 1.53; 95% CI 1.20-1.96) and a history of vascular disease (OR 1.73; 95% CI 1.30- 2.30) were associated with an increased risk of ischemic stroke relative to ICH. Elevated INR at the time of admission was a significant predictor of ICH, relative to ischemic stroke. Conclusion: None of the ‘shared’ risk factors were stronger predictors of ICH compared to ischemic stroke, which has obvious implications for clinical practice. In particular, older age was more strongly associated with ischemic stroke than ICH in patients with atrial fibrillation, and therefore, should be considered as a factor favoring a decision to commence anticoagulant therapy.

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