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Risk Factors for Intracerebral Hemorrhage in Patients With Atrial Fibrillation on Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention
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 intracereb...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10561687/ https://www.ncbi.nlm.nih.gov/pubmed/33657853 http://dx.doi.org/10.1161/STROKEAHA.120.031827 |
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author | Paciaroni, Maurizio Agnelli, Giancarlo Giustozzi, Michela Caso, Valeria Toso, Elisabetta Angelini, Filippo Canavero, Isabella Micieli, Giuseppe Antonenko, Kateryna Rocco, Alessandro Diomedi, Marina Katsanos, Aristeidis H. Shoamanesh, Ashkan Giannopoulos, Sotirios Ageno, Walter Pegoraro, Samuela Putaala, Jukka Strbian, Daniel Sallinen, Hanne Mac Grory, Brian C. Furie, Karen L. Stretz, Christoph Reznik, Michael E. Alberti, Andrea Venti, Michele Mosconi, Maria Giulia Vedovati, Maria Cristina Franco, Laura Zepponi, Giorgia Romoli, Michele Zini, Andrea Brancaleoni, Laura Riva, Letizia Silvestrelli, Giorgio Ciccone, Alfonso Zedde, Maria Luisa Giorli, Elisa Kosmidou, Maria Ntais, Evangelos Palaiodimou, Lina Halvatsiotis, Panagiotis Tassinari, Tiziana Saia, Valentina Ornello, Raffaele Sacco, Simona Bandini, Fabio Mancuso, Michelangelo Orlandi, Giovanni Ferrari, Elena Pezzini, Alessandro Poli, Loris Cappellari, Manuel Forlivesi, Stefano Rigatelli, Alberto Yaghi, Shadi Scher, Erica Frontera, Jennifer A. Masotti, Luca Grifoni, Elisa Caliandro, Pietro Zauli, Aurelia Reale, Giuseppe Marcheselli, Simona Gasparro, Antonio Terruso, Valeria Arnao, Valentina Aridon, Paolo Abdul-Rahim, Azmil H. Dawson, Jesse Saggese, Carlo Emanuele Palmerini, Francesco Doronin, Boris Volodina, Vera Toni, Danilo Risitano, Angela Schirinzi, Erika Del Sette, Massimo Lochner, Piergiorgio Monaco, Serena Mannino, Marina Tassi, Rossana Guideri, Francesca Acampa, Maurizio Martini, Giuseppe Lotti, Enrico Maria Padroni, Marina Pantoni, Leonardo Rosa, Silvia Bertora, Pierluigi Ntaios, George Sagris, Dimitrios Baldi, Antonio D’Amore, Cataldo Mumoli, Nicola Porta, Cesare Denti, Licia Chiti, Alberto Corea, Francesco Acciarresi, Monica Flomin, Yuriy Popovic, Nemanja Tsivgoulis, Georgios |
author_facet | Paciaroni, Maurizio Agnelli, Giancarlo Giustozzi, Michela Caso, Valeria Toso, Elisabetta Angelini, Filippo Canavero, Isabella Micieli, Giuseppe Antonenko, Kateryna Rocco, Alessandro Diomedi, Marina Katsanos, Aristeidis H. Shoamanesh, Ashkan Giannopoulos, Sotirios Ageno, Walter Pegoraro, Samuela Putaala, Jukka Strbian, Daniel Sallinen, Hanne Mac Grory, Brian C. Furie, Karen L. Stretz, Christoph Reznik, Michael E. Alberti, Andrea Venti, Michele Mosconi, Maria Giulia Vedovati, Maria Cristina Franco, Laura Zepponi, Giorgia Romoli, Michele Zini, Andrea Brancaleoni, Laura Riva, Letizia Silvestrelli, Giorgio Ciccone, Alfonso Zedde, Maria Luisa Giorli, Elisa Kosmidou, Maria Ntais, Evangelos Palaiodimou, Lina Halvatsiotis, Panagiotis Tassinari, Tiziana Saia, Valentina Ornello, Raffaele Sacco, Simona Bandini, Fabio Mancuso, Michelangelo Orlandi, Giovanni Ferrari, Elena Pezzini, Alessandro Poli, Loris Cappellari, Manuel Forlivesi, Stefano Rigatelli, Alberto Yaghi, Shadi Scher, Erica Frontera, Jennifer A. Masotti, Luca Grifoni, Elisa Caliandro, Pietro Zauli, Aurelia Reale, Giuseppe Marcheselli, Simona Gasparro, Antonio Terruso, Valeria Arnao, Valentina Aridon, Paolo Abdul-Rahim, Azmil H. Dawson, Jesse Saggese, Carlo Emanuele Palmerini, Francesco Doronin, Boris Volodina, Vera Toni, Danilo Risitano, Angela Schirinzi, Erika Del Sette, Massimo Lochner, Piergiorgio Monaco, Serena Mannino, Marina Tassi, Rossana Guideri, Francesca Acampa, Maurizio Martini, Giuseppe Lotti, Enrico Maria Padroni, Marina Pantoni, Leonardo Rosa, Silvia Bertora, Pierluigi Ntaios, George Sagris, Dimitrios Baldi, Antonio D’Amore, Cataldo Mumoli, Nicola Porta, Cesare Denti, Licia Chiti, Alberto Corea, Francesco Acciarresi, Monica Flomin, Yuriy Popovic, Nemanja Tsivgoulis, Georgios |
author_sort | Paciaroni, Maurizio |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10561687 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-105616872023-10-10 Risk Factors for Intracerebral Hemorrhage in Patients With Atrial Fibrillation on Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention Paciaroni, Maurizio Agnelli, Giancarlo Giustozzi, Michela Caso, Valeria Toso, Elisabetta Angelini, Filippo Canavero, Isabella Micieli, Giuseppe Antonenko, Kateryna Rocco, Alessandro Diomedi, Marina Katsanos, Aristeidis H. Shoamanesh, Ashkan Giannopoulos, Sotirios Ageno, Walter Pegoraro, Samuela Putaala, Jukka Strbian, Daniel Sallinen, Hanne Mac Grory, Brian C. Furie, Karen L. Stretz, Christoph Reznik, Michael E. Alberti, Andrea Venti, Michele Mosconi, Maria Giulia Vedovati, Maria Cristina Franco, Laura Zepponi, Giorgia Romoli, Michele Zini, Andrea Brancaleoni, Laura Riva, Letizia Silvestrelli, Giorgio Ciccone, Alfonso Zedde, Maria Luisa Giorli, Elisa Kosmidou, Maria Ntais, Evangelos Palaiodimou, Lina Halvatsiotis, Panagiotis Tassinari, Tiziana Saia, Valentina Ornello, Raffaele Sacco, Simona Bandini, Fabio Mancuso, Michelangelo Orlandi, Giovanni Ferrari, Elena Pezzini, Alessandro Poli, Loris Cappellari, Manuel Forlivesi, Stefano Rigatelli, Alberto Yaghi, Shadi Scher, Erica Frontera, Jennifer A. Masotti, Luca Grifoni, Elisa Caliandro, Pietro Zauli, Aurelia Reale, Giuseppe Marcheselli, Simona Gasparro, Antonio Terruso, Valeria Arnao, Valentina Aridon, Paolo Abdul-Rahim, Azmil H. Dawson, Jesse Saggese, Carlo Emanuele Palmerini, Francesco Doronin, Boris Volodina, Vera Toni, Danilo Risitano, Angela Schirinzi, Erika Del Sette, Massimo Lochner, Piergiorgio Monaco, Serena Mannino, Marina Tassi, Rossana Guideri, Francesca Acampa, Maurizio Martini, Giuseppe Lotti, Enrico Maria Padroni, Marina Pantoni, Leonardo Rosa, Silvia Bertora, Pierluigi Ntaios, George Sagris, Dimitrios Baldi, Antonio D’Amore, Cataldo Mumoli, Nicola Porta, Cesare Denti, Licia Chiti, Alberto Corea, Francesco Acciarresi, Monica Flomin, Yuriy Popovic, Nemanja Tsivgoulis, Georgios Stroke Brief Reports 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. Lippincott Williams & Wilkins 2021-03-04 2021-04 /pmc/articles/PMC10561687/ /pubmed/33657853 http://dx.doi.org/10.1161/STROKEAHA.120.031827 Text en © 2021 The Authors. https://creativecommons.org/licenses/by/4.0/Stroke is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited. |
spellingShingle | Brief Reports Paciaroni, Maurizio Agnelli, Giancarlo Giustozzi, Michela Caso, Valeria Toso, Elisabetta Angelini, Filippo Canavero, Isabella Micieli, Giuseppe Antonenko, Kateryna Rocco, Alessandro Diomedi, Marina Katsanos, Aristeidis H. Shoamanesh, Ashkan Giannopoulos, Sotirios Ageno, Walter Pegoraro, Samuela Putaala, Jukka Strbian, Daniel Sallinen, Hanne Mac Grory, Brian C. Furie, Karen L. Stretz, Christoph Reznik, Michael E. Alberti, Andrea Venti, Michele Mosconi, Maria Giulia Vedovati, Maria Cristina Franco, Laura Zepponi, Giorgia Romoli, Michele Zini, Andrea Brancaleoni, Laura Riva, Letizia Silvestrelli, Giorgio Ciccone, Alfonso Zedde, Maria Luisa Giorli, Elisa Kosmidou, Maria Ntais, Evangelos Palaiodimou, Lina Halvatsiotis, Panagiotis Tassinari, Tiziana Saia, Valentina Ornello, Raffaele Sacco, Simona Bandini, Fabio Mancuso, Michelangelo Orlandi, Giovanni Ferrari, Elena Pezzini, Alessandro Poli, Loris Cappellari, Manuel Forlivesi, Stefano Rigatelli, Alberto Yaghi, Shadi Scher, Erica Frontera, Jennifer A. Masotti, Luca Grifoni, Elisa Caliandro, Pietro Zauli, Aurelia Reale, Giuseppe Marcheselli, Simona Gasparro, Antonio Terruso, Valeria Arnao, Valentina Aridon, Paolo Abdul-Rahim, Azmil H. Dawson, Jesse Saggese, Carlo Emanuele Palmerini, Francesco Doronin, Boris Volodina, Vera Toni, Danilo Risitano, Angela Schirinzi, Erika Del Sette, Massimo Lochner, Piergiorgio Monaco, Serena Mannino, Marina Tassi, Rossana Guideri, Francesca Acampa, Maurizio Martini, Giuseppe Lotti, Enrico Maria Padroni, Marina Pantoni, Leonardo Rosa, Silvia Bertora, Pierluigi Ntaios, George Sagris, Dimitrios Baldi, Antonio D’Amore, Cataldo Mumoli, Nicola Porta, Cesare Denti, Licia Chiti, Alberto Corea, Francesco Acciarresi, Monica Flomin, Yuriy Popovic, Nemanja Tsivgoulis, Georgios Risk Factors for Intracerebral Hemorrhage in Patients With Atrial Fibrillation on Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention |
title | Risk Factors for Intracerebral Hemorrhage in Patients With Atrial Fibrillation on Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention |
title_full | Risk Factors for Intracerebral Hemorrhage in Patients With Atrial Fibrillation on Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention |
title_fullStr | Risk Factors for Intracerebral Hemorrhage in Patients With Atrial Fibrillation on Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention |
title_full_unstemmed | Risk Factors for Intracerebral Hemorrhage in Patients With Atrial Fibrillation on Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention |
title_short | Risk Factors for Intracerebral Hemorrhage in Patients With Atrial Fibrillation on Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention |
title_sort | risk factors for intracerebral hemorrhage in patients with atrial fibrillation on non–vitamin k antagonist oral anticoagulants for stroke prevention |
topic | Brief Reports |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10561687/ https://www.ncbi.nlm.nih.gov/pubmed/33657853 http://dx.doi.org/10.1161/STROKEAHA.120.031827 |
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riskfactorsforintracerebralhemorrhageinpatientswithatrialfibrillationonnonvitaminkantagonistoralanticoagulantsforstrokeprevention AT baldiantonio riskfactorsforintracerebralhemorrhageinpatientswithatrialfibrillationonnonvitaminkantagonistoralanticoagulantsforstrokeprevention AT damorecataldo riskfactorsforintracerebralhemorrhageinpatientswithatrialfibrillationonnonvitaminkantagonistoralanticoagulantsforstrokeprevention AT mumolinicola riskfactorsforintracerebralhemorrhageinpatientswithatrialfibrillationonnonvitaminkantagonistoralanticoagulantsforstrokeprevention AT portacesare riskfactorsforintracerebralhemorrhageinpatientswithatrialfibrillationonnonvitaminkantagonistoralanticoagulantsforstrokeprevention AT dentilicia riskfactorsforintracerebralhemorrhageinpatientswithatrialfibrillationonnonvitaminkantagonistoralanticoagulantsforstrokeprevention AT chitialberto riskfactorsforintracerebralhemorrhageinpatientswithatrialfibrillationonnonvitaminkantagonistoralanticoagulantsforstrokeprevention AT coreafrancesco riskfactorsforintracerebralhemorrhageinpatientswithatrialfibrillationonnonvitaminkantagonistoralanticoagulantsforstrokeprevention AT acciarresimonica riskfactorsforintracerebralhemorrhageinpatientswithatrialfibrillationonnonvitaminkantagonistoralanticoagulantsforstrokeprevention AT flominyuriy riskfactorsforintracerebralhemorrhageinpatientswithatrialfibrillationonnonvitaminkantagonistoralanticoagulantsforstrokeprevention AT popovicnemanja riskfactorsforintracerebralhemorrhageinpatientswithatrialfibrillationonnonvitaminkantagonistoralanticoagulantsforstrokeprevention AT tsivgoulisgeorgios riskfactorsforintracerebralhemorrhageinpatientswithatrialfibrillationonnonvitaminkantagonistoralanticoagulantsforstrokeprevention |