Disclosures: One study author reports receiving nonfinancial support from Boehringer Ingelheim and Pfizer and personal fees from Pfizer-Bristol Myers Squibb outside the submitted work. The other authors report no relevant financial disclosures.
November 24, 2021
2 min read
Save

Study reveals potential risk factors for lobar ICH in cerebral amyloid angiopathy

Disclosures: One study author reports receiving nonfinancial support from Boehringer Ingelheim and Pfizer and personal fees from Pfizer-Bristol Myers Squibb outside the submitted work. The other authors report no relevant financial disclosures.
You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Antithrombotic use after a transient focal neurological episode, as well as motor forms of these episodes, increased risk for lobar intracerebral hemorrhage, according to results of a systematic review and meta-analysis.

“Specific [transient focal neurological episode (TFNE)]-associated risk factors for lobar hemorrhage or mortality have not been studied, to our knowledge,” Juan María Sanchez-Caro, MD, of the department of neurology at the Hospital La Paz Institute for Health Research–IdiPAZ in Spain, and colleagues wrote. “We believe there is a knowledge gap in the clinical and radiological characteristics of TFNEs and their potential implications in [cerebral amyloid angiopathy (CAA)] prognosis.”

To address this research gap, the investigators conducted a systematic review and individual participant meta-analysis incorporating data from a hospital-based cohort and a systematic search of two databases completed in December 2019. They included observational reports of TFNEs that had patient-level clinical, imaging and prognostic data. They requested patient-level data for aggregate data studies.

Exposures included the clinical characteristics of TFNEs, neuroimaging features and antithrombotic use during follow-up. Lobar intracerebral hemorrhage (ICH) and risk for death during follow-up served as the predefined main outcomes.

Sanchez-Caro and colleagues included 42 studies and 222 CAA-associated cases from the initial 1,612 records returned via the systematic search. The hospital-based cohort provided 26 additional patients. Results showed 108 TFNEs (43.5%) consisted of motor symptoms. The researchers reported convexity subarachnoid hemorrhage and cortical superficial siderosis among 193 patients (77.8%) in the systematic search and 156 patients (62.9%) in the hospital-based cohort.

They obtained follow-up duration (median duration, 1 year) from 185 patients. They noted symptomatic lobar ICH among 76 patients (39.4%) during follow-up. Motor symptoms (OR = 2.08; 95% CI, 1.16-3.7) at baseline and antithrombotic use during follow-up (OR = 3.61; 95% CI, 1.67-7.84) correlated with increased risk for lobar ICH. During follow-up, 31 patients (16.5%) died. The main risk factors for death were lobar ICH during follow-up (OR = 3.01; 95% CI, 1.36-6.69) and cortical superficial siderosis (OR = 3.2; 95% CI, 1.16-8.91).

“This study reveals motor TFNEs and antithrombotic treatment as potential risk factors for lobar ICH in CAA and supports the association between [cortical superficial siderosis] and an increase in mortality,” Sanchez-Caro and colleagues wrote. “Through a better understanding of TFNEs and CAA and a more accurate stratification of the hemorrhage risk, our work could help clinicians improve the management of patients with CAA.”