Hematoma volume tied to short-term risk of ischaemic stroke

The initial volume of hematoma appears to influence the short-term risk of ischaemic stroke in patients with intracerebral haemorrhage (ICH), according to a study.

For the study, researchers pooled individual patient data from two trials: MISTIE III (Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation Phase III) and ATACH-2 (Antihypertensive Treatment of Acute Cerebral Hemorrhage-2).

The primary outcome of a symptomatic, clinically overt ischaemic stroke (adjudicated centrally within MISTIE III and ATACH-2) was evaluated in relation to hematoma volume, which was treated as a continuous measure. Multivariable Cox regression models were used in the analyses.

The analysis included 1,470 patients with ICH (mean age 61.7years, 38.3 percent women), with the median hematoma volume being 17.3 mL.

Over a median follow-up of 107 days, 30 episodes of ischaemic stroke occurred. Of these, 22 were recorded among patients with a median ICH volume of ≥17.3 mL, yielding a cumulative incidence of 4.6 percent (95 percent confidence interval [CI], 3.1–7.1). The remaining eight ischaemic stroke episodes were documented among patients with a median ICH volume of <17.3 mL, with a cumulative incidence of 3.1 percent (95 percent CI, 1.7–6.0).

In the primary analysis, every 1-mL increase in ICH volume was associated with a 2-percent increase in the risk of ischaemic stroke (hazard ratio, 1.02, 95 percent CI, 1.01–1.04). In secondary analyses, ICH volume of ≥17.3 mL was associated with a more than twofold risk increase (hazard ratio, 2.5, 95 percent CI, 1.1–7.2) compared with an ICH volume of <17.3 mL.