Intracerebral haemorrhage carries elevated short-term risk of ischaemic stroke in elderly

Elderly patients with intracerebral haemorrhage (ICH) are at high risk of ischaemic stroke in the first 6 months following diagnosis, a study has found.

Researchers used claims data from 1,760,439 Medicare beneficiaries, among whom 5,924 had ICH. Patients with vs without ICH were older (mean, 79.4 vs 73.5 years) and more likely to have hypertension, coronary artery disease, atrial fibrillation and valvular heart disease.

The primary outcome of a composite of acute ischaemic stroke and myocardial infarction (MI) were diagnosed in 137,912 patients (7.8 percent) in the cohort. The 1-year cumulative incidence of an arterial ischaemic event was 5.7 percent (95 percent confidence interval [CI], 4.8–6.8) in the ICH group and 1.8 percent (95 percent CI, 1.7–1.9) in the non-ICH group.

Multivariable Cox models showed that the risk of an arterial ischaemic event was pronounced in the first month after ICH diagnosis (hazard ratio [HR], 6.7, 95 percent CI, 5.0–8.6) and remained significantly increased for the first 6 months.

In a separate analysis of stroke and MI, ICH was associated with an increased risk of ischaemic stroke in the first 6 months after diagnosis (HR, 6.1, 95 percent CI, 3.5–9.3). This was not true for the risk of MI (HR, 1.6, 95 percent CI, 0.3–2.9).

In sensitivity analyses excluding patients with atrial fibrillation and valvular heart disease, the association between ICH and arterial ischaemic events was similar to that observed in the primary analysis.

The results suggest that elderly patients with ICH have a substantially increased risk of ischaemic stroke in the first 6 months after diagnosis, the researchers said, underscoring a need for further exploration to determine optimal secondary prevention strategies in this population.