Cirrhosis Tied to Increased Stroke Risk
Patients with cirrhosis have a significantly increased risk of
stroke, particularly hemorrhagic stroke, a retrospective cohort study of
some showed.
In a nationally representative sample of 1,618,059 patients, the incidence of stroke was 2.17% per year in patients with cirrhosis and 1.11% annually in patients without cirrhosis, according to researchers.
Although patients with cirrhosis had a higher risk of any kind of stroke (HR 1.4) than those without cirrhosis, the association between cirrhosis and stroke appeared to be much stronger for subarachnoid hemorrhage (HR 2.4) and intracerebral hemorrhage (HR 1.9) than for ischemic stroke (HR 1.3), the study authors reported online in a journal.
Similar associations were seen regardless of cirrhosis type in the 5% sample of Medicare inpatient and outpatient claims submitted from Jan. 1, 2008, through Dec. 31, 2014. However, the strongest association with stroke was seen in decompensated cirrhosis, lead researcher and colleagues said.
"Additional investigation into the epidemiology and pathophysiology of this association may yield opportunities for stroke risk reduction and prevention," they said, noting that their findings could potentially be explained by the mixed coagulopathy seen in cirrhosis. "The increased risk of ischemic and hemorrhagic stroke observed in our study may reflect these complex coagulation system aberrations, particularly for patients with more advanced, decompensated cirrhosis because these patients appeared to have a higher risk of all stroke types."
The study did not show any association between mild, non-cirrhotic liver disease and stroke.
These data "challenge the prevailing notion that cirrhosis is protective against stroke, an idea which can be traced to autopsy studies decades old," lead scientist said. "In the context of recent data demonstrating that patients with cirrhosis are not protected against venous thromboembolism, our results suggest that clinicians caring for patients with cirrhosis should perhaps remain vigilant of risk factors for both thrombotic and hemorrhagic complications," he wrote in an email.
In the 5% Medicare sample, 15,586 individuals (1.0%) had cirrhosis, with mean age 74.1. Just under half were women. During a mean followup of 4.3 years, 77,268 people in the sample were hospitalized with a stroke. These patients tended to be older, female, and had more risk factors for stroke, including hypertension, diabetes, coronary heart disease, chronic pulmonary disease and atrial fibrillation. The association between cirrhosis and thrombotic events was similar for both fatal and nonfatal stroke.
Mild liver disease was not associated with stroke (HR 0.8), ischemic stroke (HR 0.7), intracerebral hemorrhage (HR 1.1), or subarachnoid hemorrhage (HR 1.2).
Portal hypertensive hemorrhage in the gastrointestinal tract is commonly seen in patients with cirrhosis, the study authors noted, emphasizing that "these findings "support a hemorrhagic tendency in cirrhosis that is independent of portal hypertension. "On the other hand," they added, "a propensity for venous thromboembolism in cirrhosis is increasingly recognized."
Although an earlier study of patients with non-alcohol-related cirrhosis reported that cirrhosis was associated with a lower risk of stroke, "important differences in study design and patient characteristics may explain our discrepant findings," they said.
Not only does cirrhosis not appear to be protective against stroke, but the disease may actually amplify underlying vascular risk factors, researchers stated. Compounding this, the risk factors for cirrhosis -- alcohol abuse, hepatitis C infection and metabolic disease -- may also increase stroke risk.
After performing a number of post sensitivity analyses and adjusting for additional comorbidities, the study results didn't change significantly, they reported. Similarly, brain imaging at the time of an outcome didn't change the results of the primary analysis.
Study limitations included use of a diagnosis code algorithm that prioritized positive predictive value over sensitivity in determining cirrhosis. For this reason, it's possible that some of the control patients had cirrhosis, the study authors noted.
Also, information about the duration of cirrhosis before inclusion in the cohort was not available so it couldn't be confirmed that all strokes were first-ever outcomes despite efforts to exclude patients with prior stroke. Finally, the cohort was made up of insurance beneficiaries and results may not be generalizable to younger patients.
this is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.
https://gscrochetdesigns.blogspot.com. one can see my crochet creations
https://gseasyrecipes.blogspot.com. feel free to view for easy, simple and healthy recipes
https://kneereplacement-stickclub.blogspot.com. for info on knee replacement
In a nationally representative sample of 1,618,059 patients, the incidence of stroke was 2.17% per year in patients with cirrhosis and 1.11% annually in patients without cirrhosis, according to researchers.
Although patients with cirrhosis had a higher risk of any kind of stroke (HR 1.4) than those without cirrhosis, the association between cirrhosis and stroke appeared to be much stronger for subarachnoid hemorrhage (HR 2.4) and intracerebral hemorrhage (HR 1.9) than for ischemic stroke (HR 1.3), the study authors reported online in a journal.
Similar associations were seen regardless of cirrhosis type in the 5% sample of Medicare inpatient and outpatient claims submitted from Jan. 1, 2008, through Dec. 31, 2014. However, the strongest association with stroke was seen in decompensated cirrhosis, lead researcher and colleagues said.
"Additional investigation into the epidemiology and pathophysiology of this association may yield opportunities for stroke risk reduction and prevention," they said, noting that their findings could potentially be explained by the mixed coagulopathy seen in cirrhosis. "The increased risk of ischemic and hemorrhagic stroke observed in our study may reflect these complex coagulation system aberrations, particularly for patients with more advanced, decompensated cirrhosis because these patients appeared to have a higher risk of all stroke types."
The study did not show any association between mild, non-cirrhotic liver disease and stroke.
These data "challenge the prevailing notion that cirrhosis is protective against stroke, an idea which can be traced to autopsy studies decades old," lead scientist said. "In the context of recent data demonstrating that patients with cirrhosis are not protected against venous thromboembolism, our results suggest that clinicians caring for patients with cirrhosis should perhaps remain vigilant of risk factors for both thrombotic and hemorrhagic complications," he wrote in an email.
In the 5% Medicare sample, 15,586 individuals (1.0%) had cirrhosis, with mean age 74.1. Just under half were women. During a mean followup of 4.3 years, 77,268 people in the sample were hospitalized with a stroke. These patients tended to be older, female, and had more risk factors for stroke, including hypertension, diabetes, coronary heart disease, chronic pulmonary disease and atrial fibrillation. The association between cirrhosis and thrombotic events was similar for both fatal and nonfatal stroke.
Mild liver disease was not associated with stroke (HR 0.8), ischemic stroke (HR 0.7), intracerebral hemorrhage (HR 1.1), or subarachnoid hemorrhage (HR 1.2).
Portal hypertensive hemorrhage in the gastrointestinal tract is commonly seen in patients with cirrhosis, the study authors noted, emphasizing that "these findings "support a hemorrhagic tendency in cirrhosis that is independent of portal hypertension. "On the other hand," they added, "a propensity for venous thromboembolism in cirrhosis is increasingly recognized."
Although an earlier study of patients with non-alcohol-related cirrhosis reported that cirrhosis was associated with a lower risk of stroke, "important differences in study design and patient characteristics may explain our discrepant findings," they said.
Not only does cirrhosis not appear to be protective against stroke, but the disease may actually amplify underlying vascular risk factors, researchers stated. Compounding this, the risk factors for cirrhosis -- alcohol abuse, hepatitis C infection and metabolic disease -- may also increase stroke risk.
After performing a number of post sensitivity analyses and adjusting for additional comorbidities, the study results didn't change significantly, they reported. Similarly, brain imaging at the time of an outcome didn't change the results of the primary analysis.
Study limitations included use of a diagnosis code algorithm that prioritized positive predictive value over sensitivity in determining cirrhosis. For this reason, it's possible that some of the control patients had cirrhosis, the study authors noted.
Also, information about the duration of cirrhosis before inclusion in the cohort was not available so it couldn't be confirmed that all strokes were first-ever outcomes despite efforts to exclude patients with prior stroke. Finally, the cohort was made up of insurance beneficiaries and results may not be generalizable to younger patients.
this is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.
https://gscrochetdesigns.blogspot.com. one can see my crochet creations
https://gseasyrecipes.blogspot.com. feel free to view for easy, simple and healthy recipes
https://kneereplacement-stickclub.blogspot.com. for info on knee replacement
Labels: cirrhosis, coagulopathy, intracerebral hemorrhage, ischemic, stroke risk, subarachnoid hemorrhage, venous thromboembolism (VTE)
posted by G S Iyer at 10:15 AM
0 Comments:
Post a Comment
<< Home