Incidence of intracranial bleeds in new users of low-dose aspirin: a cohort study using The Health Improvement Network

Lucía Cea Soriano, David Gaist, Montse Soriano-Gabarró, Luis A Garcia Rodriguez

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: Low-dose aspirin protects against ischemic cardiovascular (CV) events as well as colorectal cancer (CRC). However, low-dose aspirin may be associated with a small increased risk of intracranial bleeds (ICB).

OBJECTIVES: To obtain incidence rates of ICB overall and by patient subgroups among new users of low-dose aspirin.

PATIENTS/METHODS: Using The Health Improvement Network (THIN) UK primary care database (2000-2012), we identified a cohort of new users of low-dose aspirin aged 40-84 years (N=199,079; mean age at start of follow-up, 63.9 years) and followed them, for up to 14 years (median 5.58 years). Incident cases of ICB were identified and validated through linkage to hospitalization data and/or review of THIN records with free-text comments. Incidence rates with 95% confidence intervals (CI) were calculated.

RESULTS: 881 incident cases of ICB were identified: 407 cases of intracerebral hemorrhage (ICH), 283 cases of subdural hematoma (SDH) and 191 cases of subarachnoid hemorrhage (SAH). Incidence rates (95% CI) per 100 person-years were 0.08 (CI 0.07-0.08) for all ICB, 0.04 (CI 0.03-0.04) for ICH, 0.02 (CI 0.02-0.03) for SDH, 0.02 (CI 0.01-0.02) for SAH. The ICB incidence rates per 100 person-years for individuals with an indication of primary CV disease prevention were 0.07 (CI 0.06-0.07) and 0.09 (CI 0.08-0.10) for secondary CV disease prevention. Incidence rates were higher in men for SDH, and higher in women for ICH and SAH.

CONCLUSIONS: Our results provide valuable estimates of the absolute risk of ICB for incorporation into risk-benefit assessments of low-dose aspirin use. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalJournal of Thrombosis and Haemostasis
Volume15
Issue number6
Pages (from-to)1055–1064
ISSN1538-7933
DOIs
Publication statusPublished - 2017

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Cohort Studies
Confidence Intervals
Incidence
Health
Colorectal Neoplasms
Primary Health Care
Databases

Keywords

  • Journal Article

Cite this

Cea Soriano, Lucía ; Gaist, David ; Soriano-Gabarró, Montse ; Garcia Rodriguez, Luis A. / Incidence of intracranial bleeds in new users of low-dose aspirin : a cohort study using The Health Improvement Network. In: Journal of Thrombosis and Haemostasis. 2017 ; Vol. 15, No. 6. pp. 1055–1064 .
@article{13eec29430214effb5060b29d4e320d7,
title = "Incidence of intracranial bleeds in new users of low-dose aspirin: a cohort study using The Health Improvement Network",
abstract = "BACKGROUND: Low-dose aspirin protects against ischemic cardiovascular (CV) events as well as colorectal cancer (CRC). However, low-dose aspirin may be associated with a small increased risk of intracranial bleeds (ICB).OBJECTIVES: To obtain incidence rates of ICB overall and by patient subgroups among new users of low-dose aspirin.PATIENTS/METHODS: Using The Health Improvement Network (THIN) UK primary care database (2000-2012), we identified a cohort of new users of low-dose aspirin aged 40-84 years (N=199,079; mean age at start of follow-up, 63.9 years) and followed them, for up to 14 years (median 5.58 years). Incident cases of ICB were identified and validated through linkage to hospitalization data and/or review of THIN records with free-text comments. Incidence rates with 95{\%} confidence intervals (CI) were calculated.RESULTS: 881 incident cases of ICB were identified: 407 cases of intracerebral hemorrhage (ICH), 283 cases of subdural hematoma (SDH) and 191 cases of subarachnoid hemorrhage (SAH). Incidence rates (95{\%} CI) per 100 person-years were 0.08 (CI 0.07-0.08) for all ICB, 0.04 (CI 0.03-0.04) for ICH, 0.02 (CI 0.02-0.03) for SDH, 0.02 (CI 0.01-0.02) for SAH. The ICB incidence rates per 100 person-years for individuals with an indication of primary CV disease prevention were 0.07 (CI 0.06-0.07) and 0.09 (CI 0.08-0.10) for secondary CV disease prevention. Incidence rates were higher in men for SDH, and higher in women for ICH and SAH.CONCLUSIONS: Our results provide valuable estimates of the absolute risk of ICB for incorporation into risk-benefit assessments of low-dose aspirin use. This article is protected by copyright. All rights reserved.",
keywords = "Journal Article",
author = "{Cea Soriano}, Luc{\'i}a and David Gaist and Montse Soriano-Gabarr{\'o} and {Garcia Rodriguez}, {Luis A}",
note = "This article is protected by copyright. All rights reserved.",
year = "2017",
doi = "10.1111/jth.13686",
language = "English",
volume = "15",
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journal = "Journal of Thrombosis and Haemostasis",
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Incidence of intracranial bleeds in new users of low-dose aspirin : a cohort study using The Health Improvement Network. / Cea Soriano, Lucía; Gaist, David; Soriano-Gabarró, Montse; Garcia Rodriguez, Luis A.

In: Journal of Thrombosis and Haemostasis, Vol. 15, No. 6, 2017, p. 1055–1064 .

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Incidence of intracranial bleeds in new users of low-dose aspirin

T2 - a cohort study using The Health Improvement Network

AU - Cea Soriano, Lucía

AU - Gaist, David

AU - Soriano-Gabarró, Montse

AU - Garcia Rodriguez, Luis A

N1 - This article is protected by copyright. All rights reserved.

PY - 2017

Y1 - 2017

N2 - BACKGROUND: Low-dose aspirin protects against ischemic cardiovascular (CV) events as well as colorectal cancer (CRC). However, low-dose aspirin may be associated with a small increased risk of intracranial bleeds (ICB).OBJECTIVES: To obtain incidence rates of ICB overall and by patient subgroups among new users of low-dose aspirin.PATIENTS/METHODS: Using The Health Improvement Network (THIN) UK primary care database (2000-2012), we identified a cohort of new users of low-dose aspirin aged 40-84 years (N=199,079; mean age at start of follow-up, 63.9 years) and followed them, for up to 14 years (median 5.58 years). Incident cases of ICB were identified and validated through linkage to hospitalization data and/or review of THIN records with free-text comments. Incidence rates with 95% confidence intervals (CI) were calculated.RESULTS: 881 incident cases of ICB were identified: 407 cases of intracerebral hemorrhage (ICH), 283 cases of subdural hematoma (SDH) and 191 cases of subarachnoid hemorrhage (SAH). Incidence rates (95% CI) per 100 person-years were 0.08 (CI 0.07-0.08) for all ICB, 0.04 (CI 0.03-0.04) for ICH, 0.02 (CI 0.02-0.03) for SDH, 0.02 (CI 0.01-0.02) for SAH. The ICB incidence rates per 100 person-years for individuals with an indication of primary CV disease prevention were 0.07 (CI 0.06-0.07) and 0.09 (CI 0.08-0.10) for secondary CV disease prevention. Incidence rates were higher in men for SDH, and higher in women for ICH and SAH.CONCLUSIONS: Our results provide valuable estimates of the absolute risk of ICB for incorporation into risk-benefit assessments of low-dose aspirin use. This article is protected by copyright. All rights reserved.

AB - BACKGROUND: Low-dose aspirin protects against ischemic cardiovascular (CV) events as well as colorectal cancer (CRC). However, low-dose aspirin may be associated with a small increased risk of intracranial bleeds (ICB).OBJECTIVES: To obtain incidence rates of ICB overall and by patient subgroups among new users of low-dose aspirin.PATIENTS/METHODS: Using The Health Improvement Network (THIN) UK primary care database (2000-2012), we identified a cohort of new users of low-dose aspirin aged 40-84 years (N=199,079; mean age at start of follow-up, 63.9 years) and followed them, for up to 14 years (median 5.58 years). Incident cases of ICB were identified and validated through linkage to hospitalization data and/or review of THIN records with free-text comments. Incidence rates with 95% confidence intervals (CI) were calculated.RESULTS: 881 incident cases of ICB were identified: 407 cases of intracerebral hemorrhage (ICH), 283 cases of subdural hematoma (SDH) and 191 cases of subarachnoid hemorrhage (SAH). Incidence rates (95% CI) per 100 person-years were 0.08 (CI 0.07-0.08) for all ICB, 0.04 (CI 0.03-0.04) for ICH, 0.02 (CI 0.02-0.03) for SDH, 0.02 (CI 0.01-0.02) for SAH. The ICB incidence rates per 100 person-years for individuals with an indication of primary CV disease prevention were 0.07 (CI 0.06-0.07) and 0.09 (CI 0.08-0.10) for secondary CV disease prevention. Incidence rates were higher in men for SDH, and higher in women for ICH and SAH.CONCLUSIONS: Our results provide valuable estimates of the absolute risk of ICB for incorporation into risk-benefit assessments of low-dose aspirin use. This article is protected by copyright. All rights reserved.

KW - Journal Article

U2 - 10.1111/jth.13686

DO - 10.1111/jth.13686

M3 - Journal article

C2 - 28371181

VL - 15

SP - 1055

EP - 1064

JO - Journal of Thrombosis and Haemostasis

JF - Journal of Thrombosis and Haemostasis

SN - 1538-7933

IS - 6

ER -