Antithrombotic drugs and risk of hemorrhagic stroke in the general population

Luis A García-Rodríguez, David Gaist, Jonathan Morton, Charlotte Cookson, Antonio González-Pérez

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

OBJECTIVE: To investigate the relationship between hemorrhagic stroke and use of antiplatelets and warfarin using data from The Health Improvement Network.

METHODS: A total of 1,797 incident cases of intracerebral hemorrhage (ICH) and 1,340 of subarachnoid hemorrhage (SAH) were ascertained. Density-based sampling was used to select 10,000 controls free from hemorrhagic stroke. Risk of hemorrhagic stroke was evaluated in current users and nonusers of antiplatelets and warfarin. Unconditional logistic regression models were used to adjust for age, sex, calendar year, alcohol, body mass index, hypertension, and health services utilization.

RESULTS: Aspirin use was not associated with an increased risk of ICH (odds ratio [OR] 1.06, 95% confidence interval [CI] 0.93-1.21), but was associated with a decreased risk of SAH (OR 0.82, 95% CI 0.67-1.00), compared with no therapy. Aspirin use ≥3 years was associated with a decreased risk of SAH (OR 0.63, 95% CI 0.45-0.90) compared with no therapy. Warfarin use was associated with a greatly increased risk of ICH (OR 2.82, 95% CI 2.26-3.53) and a moderately increased risk of SAH (OR 1.67, 95% CI 1.15-2.43) compared with no therapy. International normalized ratio values ≥3 carried a marked risk of ICH (OR 7.01, 95% CI 4.10-11.99).

CONCLUSION: Aspirin is not associated with a risk of ICH compared with no therapy. Chronic low-dose aspirin treatment may have a protective effect on the risk of SAH. Warfarin users in this study cohort were at a much higher risk of ICH than those receiving no therapy, with a marked association with international normalized ratio >3.

Original languageEnglish
JournalNeurology
Volume81
Issue number6
Pages (from-to)566-574
ISSN0028-3878
DOIs
Publication statusPublished - 2013

Fingerprint

Pharmaceutical Preparations
Population
Odds Ratio
Warfarin
Confidence Intervals
International Normalized Ratio
Logistic Models
Health Services
Body Mass Index
Cohort Studies
Alcohols
Health

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Aspirin
  • Case-Control Studies
  • Cohort Studies
  • Female
  • Fibrinolytic Agents
  • Humans
  • Intracranial Hemorrhages
  • Male
  • Middle Aged
  • Population Surveillance
  • Risk Factors
  • Stroke
  • Warfarin
  • Young Adult

Cite this

García-Rodríguez, L. A., Gaist, D., Morton, J., Cookson, C., & González-Pérez, A. (2013). Antithrombotic drugs and risk of hemorrhagic stroke in the general population. Neurology, 81(6), 566-574. https://doi.org/10.1212/WNL.0b013e31829e6ffa
García-Rodríguez, Luis A ; Gaist, David ; Morton, Jonathan ; Cookson, Charlotte ; González-Pérez, Antonio. / Antithrombotic drugs and risk of hemorrhagic stroke in the general population. In: Neurology. 2013 ; Vol. 81, No. 6. pp. 566-574.
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abstract = "OBJECTIVE: To investigate the relationship between hemorrhagic stroke and use of antiplatelets and warfarin using data from The Health Improvement Network.METHODS: A total of 1,797 incident cases of intracerebral hemorrhage (ICH) and 1,340 of subarachnoid hemorrhage (SAH) were ascertained. Density-based sampling was used to select 10,000 controls free from hemorrhagic stroke. Risk of hemorrhagic stroke was evaluated in current users and nonusers of antiplatelets and warfarin. Unconditional logistic regression models were used to adjust for age, sex, calendar year, alcohol, body mass index, hypertension, and health services utilization.RESULTS: Aspirin use was not associated with an increased risk of ICH (odds ratio [OR] 1.06, 95{\%} confidence interval [CI] 0.93-1.21), but was associated with a decreased risk of SAH (OR 0.82, 95{\%} CI 0.67-1.00), compared with no therapy. Aspirin use ≥3 years was associated with a decreased risk of SAH (OR 0.63, 95{\%} CI 0.45-0.90) compared with no therapy. Warfarin use was associated with a greatly increased risk of ICH (OR 2.82, 95{\%} CI 2.26-3.53) and a moderately increased risk of SAH (OR 1.67, 95{\%} CI 1.15-2.43) compared with no therapy. International normalized ratio values ≥3 carried a marked risk of ICH (OR 7.01, 95{\%} CI 4.10-11.99).CONCLUSION: Aspirin is not associated with a risk of ICH compared with no therapy. Chronic low-dose aspirin treatment may have a protective effect on the risk of SAH. Warfarin users in this study cohort were at a much higher risk of ICH than those receiving no therapy, with a marked association with international normalized ratio >3.",
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García-Rodríguez, LA, Gaist, D, Morton, J, Cookson, C & González-Pérez, A 2013, 'Antithrombotic drugs and risk of hemorrhagic stroke in the general population', Neurology, vol. 81, no. 6, pp. 566-574. https://doi.org/10.1212/WNL.0b013e31829e6ffa

Antithrombotic drugs and risk of hemorrhagic stroke in the general population. / García-Rodríguez, Luis A; Gaist, David; Morton, Jonathan; Cookson, Charlotte; González-Pérez, Antonio.

In: Neurology, Vol. 81, No. 6, 2013, p. 566-574.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Antithrombotic drugs and risk of hemorrhagic stroke in the general population

AU - García-Rodríguez, Luis A

AU - Gaist, David

AU - Morton, Jonathan

AU - Cookson, Charlotte

AU - González-Pérez, Antonio

PY - 2013

Y1 - 2013

N2 - OBJECTIVE: To investigate the relationship between hemorrhagic stroke and use of antiplatelets and warfarin using data from The Health Improvement Network.METHODS: A total of 1,797 incident cases of intracerebral hemorrhage (ICH) and 1,340 of subarachnoid hemorrhage (SAH) were ascertained. Density-based sampling was used to select 10,000 controls free from hemorrhagic stroke. Risk of hemorrhagic stroke was evaluated in current users and nonusers of antiplatelets and warfarin. Unconditional logistic regression models were used to adjust for age, sex, calendar year, alcohol, body mass index, hypertension, and health services utilization.RESULTS: Aspirin use was not associated with an increased risk of ICH (odds ratio [OR] 1.06, 95% confidence interval [CI] 0.93-1.21), but was associated with a decreased risk of SAH (OR 0.82, 95% CI 0.67-1.00), compared with no therapy. Aspirin use ≥3 years was associated with a decreased risk of SAH (OR 0.63, 95% CI 0.45-0.90) compared with no therapy. Warfarin use was associated with a greatly increased risk of ICH (OR 2.82, 95% CI 2.26-3.53) and a moderately increased risk of SAH (OR 1.67, 95% CI 1.15-2.43) compared with no therapy. International normalized ratio values ≥3 carried a marked risk of ICH (OR 7.01, 95% CI 4.10-11.99).CONCLUSION: Aspirin is not associated with a risk of ICH compared with no therapy. Chronic low-dose aspirin treatment may have a protective effect on the risk of SAH. Warfarin users in this study cohort were at a much higher risk of ICH than those receiving no therapy, with a marked association with international normalized ratio >3.

AB - OBJECTIVE: To investigate the relationship between hemorrhagic stroke and use of antiplatelets and warfarin using data from The Health Improvement Network.METHODS: A total of 1,797 incident cases of intracerebral hemorrhage (ICH) and 1,340 of subarachnoid hemorrhage (SAH) were ascertained. Density-based sampling was used to select 10,000 controls free from hemorrhagic stroke. Risk of hemorrhagic stroke was evaluated in current users and nonusers of antiplatelets and warfarin. Unconditional logistic regression models were used to adjust for age, sex, calendar year, alcohol, body mass index, hypertension, and health services utilization.RESULTS: Aspirin use was not associated with an increased risk of ICH (odds ratio [OR] 1.06, 95% confidence interval [CI] 0.93-1.21), but was associated with a decreased risk of SAH (OR 0.82, 95% CI 0.67-1.00), compared with no therapy. Aspirin use ≥3 years was associated with a decreased risk of SAH (OR 0.63, 95% CI 0.45-0.90) compared with no therapy. Warfarin use was associated with a greatly increased risk of ICH (OR 2.82, 95% CI 2.26-3.53) and a moderately increased risk of SAH (OR 1.67, 95% CI 1.15-2.43) compared with no therapy. International normalized ratio values ≥3 carried a marked risk of ICH (OR 7.01, 95% CI 4.10-11.99).CONCLUSION: Aspirin is not associated with a risk of ICH compared with no therapy. Chronic low-dose aspirin treatment may have a protective effect on the risk of SAH. Warfarin users in this study cohort were at a much higher risk of ICH than those receiving no therapy, with a marked association with international normalized ratio >3.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Aspirin

KW - Case-Control Studies

KW - Cohort Studies

KW - Female

KW - Fibrinolytic Agents

KW - Humans

KW - Intracranial Hemorrhages

KW - Male

KW - Middle Aged

KW - Population Surveillance

KW - Risk Factors

KW - Stroke

KW - Warfarin

KW - Young Adult

U2 - 10.1212/WNL.0b013e31829e6ffa

DO - 10.1212/WNL.0b013e31829e6ffa

M3 - Journal article

C2 - 23843464

VL - 81

SP - 566

EP - 574

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 6

ER -