Incidence Of Intracranial Hemorrhage In Patients Research Articles

Incidence of intracranial bleeding in mild traumatic brain injury patients taking oral anticoagulants: a systematic review and meta-analysis.

Traumatic brain injury (TBI) is one of the leading causes of disability and death worldwide. Most TBI cases occur in older people, because they are at a higher risk of accidental falling. As the population ages, the use of anticoagulants is increasing. Some serious complications of TBI, such as intracranial hemorrhage (ICH), may occur even in mild cases. According to the current guidelines regarding managing mild TBI patients, a CT head scan is recommended for all patients receiving anticoagulation. We aim to assess the incidence of ICH in patients with mild TBI taking oral anticoagulants. Our systematic review and meta-analysis were performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. The protocol was registered in PROSPERO (CRD42024503086). Twenty-eight studies evaluating patients with a mild TBI from ten countries with a total sample size of 11,172, 5671 on DOACs, and 5501 on VKAs were included in our meta-analysis. The random-effects overall incidence of ICH among oral anticoagulated patients with mild TBI was calculated to be 9.4% [95% CI 7.2-12.1%, I2 = 89%]. The rates of immediate ICH for patients taking DOACs and VKAs were 6.4% and 10.5%, respectively. The overall rate of immediate ICH in anticoagulated mild TBI patients was 8.5% [95% CI 6.6-10.9%], with a high heterogeneity between studies (I2 = 88%). Furthermore, the rates of delayed ICH in patients with mild TBI taking DOACs and VKAs were 1.6% and 1.9%, respectively. The overall incidence of delayed ICH among oral anticoagulated mild TBI patients was 1.7% [95% CI 1-2.8%, I2 = 79%]. The overall rate of ICH among mild TBI patients taking DOAC was calculated to be 7.3% [95% CI 5.2-10.3%], with significant heterogeneity between studies (I2 = 79%). However, the overall ICH rate is higher in patients who take only VKAs 11.3% [95% CI 8.6-14.7%, I2 = 83%]. Patients on DOACs were at lower risk of ICH after mild TBI compared to patients on VKAs (OR = 0.64, 95% CI 0.48-0.86, p < 0.01, I2 = 28%). Our meta-analysis confirms the need for performing brain CT scan in patients with mild TBI patients who receive oral anticoagulants before injury. Due to limited data, further multi-center, prospective studies are warranted to confirm the true incidence of traumatic ICH in patients on anticoagulants.

Incidence of Intracranial Hemorrhage in Patients Younger Than 2 Months Receiving Sodium Bicarbonate 4.2% vs 8.4.

To assess the incidence of intracranial hemorrhage (ICH), including intraventricular hemorrhage, in infants receiving 4.2% or 8.4% sodium bicarbonate. This is a single-center retrospective chart review of neonates and infants with a gestational age (GA) >32 weeks and a postnatal age <2 months who received sodium bicarbonate in an intensive care unit at an academic tertiary children's hospital. The primary outcome was the incidence of ICH in patients with baseline and follow-up head imaging. The secondary outcome was the incidence of ICH on follow-up head imaging, with or without baseline head imaging. There were 351 patients screened, with 135 meeting inclusion criteria. Of these, 84% were born ≥37 weeks GA. Forty-two met the criteria for the primary outcome. Study participants were further subdivided into 3 groups based on the concentration of sodium bicarbonate received: only 4.2%, only 8.4%, or a mixed group that received at least 1 dose each of 4.2% and 8.4%. Intracranial hemorrhage was noted in 1 patient in each group: 8.3%, 5.6%, and 8.3%, respectively (p = 1.00). For the secondary outcome, 11 ICHs were seen on head imaging: 11.3%, 3.8%, and 10%, respectively. There was no statistically significant difference in the incidence of ICH (p = 0.325). The incidence of ICH in term neonates and infants was not significantly different in those receiving 4.2% vs 8.4% sodium bicarbonate. Although additional studies are needed, this study suggests it may be possible to safely expand the use of 8.4% in neonates/infants ≥37 weeks GA. These results should not be applied to preterm neonates (<37 weeks GA and/or <1500 g) or neonates with additional ICH risk factors.

Antiplatelet medications and intracranial hemorrhage in patients with primary brain tumors

BackgroundSpontaneous intracranial hemorrhage (ICH) is a frequent and severe consequence of primary brain tumors. The safety of antiplatelet medications in this patient population is undefined. ObjectiveThe primary objective was to determine whether antiplatelet medications are associated with an increased risk of ICH in patients with primary brain tumors. Patients/MethodsWe performed a matched, retrospective cohort study of patients with the diagnosis of primary brain tumor treated at our institution between 2010 and 2021. Radiographic images of all potential ICH events underwent blinded review. The primary end point of the study was the cumulative incidence of ICH at 1 year after tumor diagnosis. Results and ConclusionsA total of 387 patients with primary brain tumors were included in the study population (130 exposed to antiplatelet agents, 257 not exposed). The most common malignancy was glioblastoma (n = 256, 66.1%). Among the intervention cohort, 119 patients received aspirin monotherapy. The cumulative incidence of any ICH at 1 year was 11.0% (95% CI, 5.3-16.6) in those receiving antiplatelet medications and 13.0% (95% CI, 8.5-17.6) in those not receiving antiplatelet medications (Gray test, p = 0.6). The cumulative incidence of major ICH was similar between the cohorts (3.3% in antiplatelet cohort vs 2.9% in control cohort, p = 1.0). This study did not identify an increased incidence of ICH in patients with primary brain tumors exposed to antiplatelet medications.

Seizures in a Term Newborn.

Seizures in a Term Newborn.

Prophylactic anticoagulation in patients with glioblastoma or brain metastases and atrial fibrillation: an increased risk for intracranial hemorrhage?

PurposePatients with glioblastoma (GBM) or brain metastases (MET) and atrial fibrillation (AF) might be at an increased risk of intracranial hemorrhage (ICH) due to anticoagulation (AC). Our aim was to assess this risk.MethodsOur institution’s database (from 2005 to 2017) was screened for patients with GBM or MET and AF with an indication for AC according to their CHA2DS2VASc stroke risk score (≥ 2). Required follow-up was at least 3 months. AC was either performed with heparins, phenprocoumon or non-Vitamin K antagonist oral anticoagulants. Applying the propensity score approach, patient cohorts (matched according to primary tumor, age, sex) were generated (GBM [or MET] with AF ± AC, GBM [or MET] without AF/AC, no GBM [or MET] but AF on AC). ICH was defined as clinical deterioration caused by new blood on imaging. A log rank test was performed to compare the risk for ICH between the three groups.ResultsIn total, 104 patients were identified of which 49 with GBM (37% on AC) and 37 with MET (46% on AC) were successfully matched. Median follow up was 8.6 and 7.2 months, respectively. ICH occurred in 10.2% of GBM + AF and 12.2% GBM-AF, whereas 8% of patients with AF on AC suffered ICH (p = 0.076). 13.5% of patients with MET + AF had ICHs, in the controls it was 16% for MET-AF and 8% for AF on AC (p = 0.11).ConclusionAC did not seem to influence the incidence of ICH in patients with glioblastoma or brain metastases within follow up of just under 9 months.

Pre-treatment cerebral microbleeds and intracranial hemorrhage in patients with ischemic stroke receiving endovascular therapy: a systematic review and meta-analysis.

Predicting the risk of intracranial hemorrhage (ICH) is an important aspect for improving the efficacy and safety of endovascular therapy (EVT). We intended to perform a systematic review and meta-analysis to show whether pre-treatment cerebral microbleeds(CMBs) were associated with an increased incidence of ICH in patients with ischemic stroke receiving EVT. We searched PubMed, EMBASE, Web of Science and Cochrane Library from their dates of inception to December 18, 2018, and also manually searched reference lists of relevant articles. Cumulative prevalence of CMBs and ICH was calculated. Relative risk and 95% confidence interval (CI) were calculated for the incidence of ICH in patients with CMBs versus those without after EVT. Four studies involving 598 patients were included. The pooled prevalence of CMBs was 18% (95% CI 15-21%) and the pooled prevalence of ≥ 5 CMBs was 1% (95% CI 0-2%). The pooled incidence of ICH was 29% (95% CI 8-49%) in all patients, 25% (95% CI 5-45%) in those with CMBs and 29% (95% CI 8-50%) in those without CMBs. The pooled relative risk of ICH was 0.90 (95% CI 0.65-1.25, P = 0.528; I2 = 0%, P = 0.949) in patients with CMBs versus those without CMBs. There is no evidence that pre-treatment CMBs were associated with an increased incidence of ICH in patients with ischemic stroke receiving EVT.

Safety of long-term anticoagulation in patients with brain metastases.

Anticoagulation is thought to be associated with the risk of intracranial hemorrhage (ICH) in patients with brain metastases; however, the data on this topic are limited. This study was conducted to determine the incidence of ICH associated with anticoagulant use in adult patients with brain metastases. Consecutive patients with brain metastases occurring from 2006 to 2014 were identified from a single-institution database. Long-term anticoagulant therapy was defined as outpatient anticoagulation therapy of >1month. Chi-square tests and Fisher's exact test were used to compare rates of ICH by groups. This cohort included 125 patients with brain metastases. Of these, 64 had primary of non-small cell lung cancer (51.2%). Of these patients, 12/125 (9.6%) patients developed ICH. Neither the primary tumor site nor the number of brain metastases was associated with the development of ICH. ICH incidence was not associated with the use of anticoagulant therapy, with 8/67 (11.94%) patients on outpatient anticoagulation and 4/58 (6.9%) not on anticoagulation experiencing ICH (p=0.33). The type of treatment did not significantly influence ICH, although those having combined WBRT and SRS were numerically more likely to experience ICH (4/15; 26.67%) of this cohort. In patients on enoxaparin, there was no difference in the incidence of ICH for daily versus twice-daily dosing (p=1.0). Long-term anticoagulant use is not associated with an increased incidence of ICH in patients with intracranial metastases.

Complications of anticoagulant therapy in patients with brain metastases.

2078 Background: Anticoagulation has long been viewed as carrying excessive risk of intracranial hemorrhage (ICH) in patients with brain metastases. However the data evaluating the exact incidence of ICH in patients on anticoagulant therapy (ACT) are sparse. This study was conducted to determine the incidence of ICH associated with ACT in adult patients with brain metastases Methods: Consecutive patients with brain metastases occurring from 2006-2014 were identified from a single institution database. Patients were categorized as having no outpatient anticoagulant therapy versus having outpatient anticoagulation therapy of greater than 1 month. Chi-square tests and Fisher’s exact test were used to compare rates of ICH by groups. Statistical analyses were carried out using SAS 9.3. Results: A total of 125 patients with brain metastases were analyzed. Of these, 64 had primary non-small cell lung cancer (51.2%), while the other primary sites included, breast (12%), melanoma and small cell lung cancer (7.2%) Overall, 12/125 (9.6%) patients had evidence of ICH. Neither the primary tumor site nor the number of brain metastases was associated with the development of ICH. Eight of 67 (11.94%) patients on outpatient ACT had evidence of ICH, compared with 4 of 58 (6.9%) patients not on ACT; however, this difference was not statistically significant (p = 0.33). In the subset of patients on enoxaparin, there was no difference in the incidence of ICH for daily versus twice daily dosing (p = 1.0). Those treated with stereotactic radiosurgery in addition to whole-brain radiotherapy (SRS+WBRT) were significantly more likely to experience ICH (p = 0.0014), however these were within the metastatic lesion and none of these events required any further intervention than ACT cessation. Conclusions: Treatment of metastases with SRS+WBRT was significantly correlated with ICH independent of ACT. Our finding that ACT does not significantly increase risk for ICH supports its use in these patients.

Risk of stroke and intracranial hemorrhage in 9727 Chinese with atrial fibrillation in Hong Kong

Current risk schemes to predict ischemic stroke and intracranial hemorrhage (ICH) in atrial fibrillation (AF) are derived primarily using a Caucasian population. The purpose of this study was to describe the risk of ischemic stroke and ICH in a large contemporary "real world" cohort of Chinese AF patients in Hong Kong with detailed long-term follow-up. This observational study used a hospital-based cohort of Chinese patients with nonvalvular AF. Among 9727 patients with nonvalvular AF (age 76.9 ± 12.5 years, 52.1% female), 3881 patients (39.9%) did not receive antithrombotic therapy, 3934 patients (40.4%) were taking aspirin, and 1912 (19.7%) were taking warfarin. After mean follow-up of 3.19 years, 847 patients (21.8%) without antithrombotic therapy developed ischemic strokes (annual risk 9.28%, 95% confidence interval [CI] 8.89%-9.70%). There was a progressively increase in annual risk of ischemic stroke with increasing CHADS2 and CHA2DS2VASc scores. The c-statistics revealed that CHA2DS2-VASc scores (0.525, 95% CI 0.509-0.541, P = .017) was better than CHADS2 scores (0.506, 95% CI 0.490-0.522, P = .584) in predicting ischemic stroke. Use of aspirin and of warfarin were associated with reduced annual risk of ischemic stroke by 18.7% and 52.7%, respectively (P <.05). The annual incidence of ICH in patients taking aspirin and warfarin was 0.77% per year and 0.80% per year, respectively. The adjusted net clinical benefit favored warfarin over aspirin or no therapy for almost all Chinese AF patients CHA2DS2-VASc score ≥1. Chinese AF patients are at high risk for ischemic stroke. Analysis of the net clinical benefit favors the use of warfarin over aspirin or no therapy for stroke prevention in a broad range of Chinese AF patients.

Intracranial hemorrhage in adult patients with hematological malignancies

BackgroundClinical characteristics and outcomes of intracranial hemorrhage (ICH) among adult patients with various hematological malignancies are limited.MethodsA total of 2,574 adult patients diagnosed with hematological malignancies admitted to a single university hospital were enrolled into this study between 2001 and 2010. The clinical characteristics, image reports and outcomes were retrospectively analyzed.ResultsA total of 72 patients (48 men and 24 women) with a median age of 56 (range 18 to 86) had an ICH. The overall ICH incidence was 2.8% among adult patients with hematological malignancies. The incidence of ICH was higher in acute myeloid leukemia (AML) patients than in patients with other hematological malignancies (6.3% vs 1.1%, P = 0.001). ICH was more common among patients with central nervous system (CNS) involvement of lymphoma than among patients with CNS involved acute leukemia (P <0.001). Sites of ICH occurrence included the cerebral cortex (60 patients, 83%), basal ganglia (13 patients, 18%), cerebellum (10 patients, 14%), and brainstem (5 patients, 7%). A total of 33 patients (46%) had multifocal hemorrhages. In all, 56 patients (77%) had intraparenchymal hemorrhage, 22 patients (31%) had subdural hemorrhage, 15 patients (21%) had subarachnoid hemorrhage (SAH), and 3 patients (4%) had epidural hemorrhage. A total of 22 patients had 2 or more types of ICH. In all, 46 (64%) patients died of ICH within 30 days of diagnosis, irrespective of the type of hematological malignancy. Multivariate analysis revealed three independent prognostic factors: prolonged prothrombin time (P = 0.008), SAH (P = 0.021), and multifocal cerebral hemorrhage (P = 0.026).ConclusionsThe incidence of ICH in patients with AML is higher than patients with other hematological malignancies. But in those with intracranial malignant disease, patients with CNS involved lymphoma were more prone to ICH than patients with CNS involved acute leukemia. Mortality was similar regardless of the type of hematological malignancy. Neuroimaging studies of the location and type of ICH could assist with prognosis prediction for patients with hematological malignancies.