Intracerebral Hemorrhage in Multiple Sclerosis: A Retrospective Cohort Study.
Adolescent
Adult
Aged
Anticoagulants
/ adverse effects
Antirheumatic Agents
/ therapeutic use
Cerebral Hemorrhage
/ diagnosis
Comorbidity
Electronic Health Records
Female
Humans
Male
Middle Aged
Multiple Sclerosis
/ diagnosis
Platelet Aggregation Inhibitors
/ therapeutic use
Prognosis
Protective Factors
Retrospective Studies
Risk Factors
Smoking
/ adverse effects
United States
/ epidemiology
Young Adult
Intracerebral hemorrhage
anticoagulant
antiplatelet
disease-modifying drugs
hemorrhagic stroke
multiple sclerosis
Journal
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
ISSN: 1532-8511
Titre abrégé: J Stroke Cerebrovasc Dis
Pays: United States
ID NLM: 9111633
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
15
06
2018
revised:
21
09
2018
accepted:
27
09
2018
pubmed:
6
11
2018
medline:
29
1
2019
entrez:
3
11
2018
Statut:
ppublish
Résumé
To identify the vascular risk factors associated with the occurrence of intracerebral hemorrhage (ICH) in Multiple Sclerosis (MS) patients. This is an observational, retrospective cohort study using the nationwide electronic medical records (EMR) database. Patients with the diagnosis of MS were extracted from inpatient and outpatient EMR using the international classification of diseases, ninth/tenth revisions, clinical modification codes. We excluded patients younger than 18 years, and those where gender was not specified. Patients were further stratified based on their demographics, risk factors, medications, and comorbidities. Tobacco, diabetes, hypertension, and alcohol were the predicting variables; antiplatelet medication, and anticoagulant agents were the primary exposures for the development of ICH. A validated diagnosis code algorithm defined the diagnosis of ICH. Multivariable logistic regression models were utilized to assess the risk of ICH in MS patients. Of the total 57,099 MS patients (women: 75%, n = 41,517), 107 (.19%) sustained an ICH. Age (OR = 2.74, CI = 1.13-6.62), use of anticoagulants (OR = 2.15, 95% CI = 1.30-3.56, P = .0028), and history of tobacco exposure (OR = 2.44, CI = 1.37-4.36, P = .0025) were associated with increased risk of ICH. Use of antiplatelet and disease-modifying drugs (DMDs) showed a protective trend against ICH. Tobacco exposure and anticoagulant use were strongly associated with increased risk of ICH in patients with MS. There might be a protective effect that antiplatelet and DMDs have in the pathophysiology of this disease. Further prospective investigations are warranted to establish these associations.
Sections du résumé
BACKGROUND
BACKGROUND
To identify the vascular risk factors associated with the occurrence of intracerebral hemorrhage (ICH) in Multiple Sclerosis (MS) patients.
METHODS
METHODS
This is an observational, retrospective cohort study using the nationwide electronic medical records (EMR) database. Patients with the diagnosis of MS were extracted from inpatient and outpatient EMR using the international classification of diseases, ninth/tenth revisions, clinical modification codes. We excluded patients younger than 18 years, and those where gender was not specified. Patients were further stratified based on their demographics, risk factors, medications, and comorbidities. Tobacco, diabetes, hypertension, and alcohol were the predicting variables; antiplatelet medication, and anticoagulant agents were the primary exposures for the development of ICH. A validated diagnosis code algorithm defined the diagnosis of ICH. Multivariable logistic regression models were utilized to assess the risk of ICH in MS patients.
RESULTS
RESULTS
Of the total 57,099 MS patients (women: 75%, n = 41,517), 107 (.19%) sustained an ICH. Age (OR = 2.74, CI = 1.13-6.62), use of anticoagulants (OR = 2.15, 95% CI = 1.30-3.56, P = .0028), and history of tobacco exposure (OR = 2.44, CI = 1.37-4.36, P = .0025) were associated with increased risk of ICH. Use of antiplatelet and disease-modifying drugs (DMDs) showed a protective trend against ICH.
CONCLUSIONS
CONCLUSIONS
Tobacco exposure and anticoagulant use were strongly associated with increased risk of ICH in patients with MS. There might be a protective effect that antiplatelet and DMDs have in the pathophysiology of this disease. Further prospective investigations are warranted to establish these associations.
Identifiants
pubmed: 30385221
pii: S1052-3057(18)30572-X
doi: 10.1016/j.jstrokecerebrovasdis.2018.09.050
pii:
doi:
Substances chimiques
Anticoagulants
0
Antirheumatic Agents
0
Platelet Aggregation Inhibitors
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
267-275Commentaires et corrections
Type : ErratumIn
Informations de copyright
Copyright © 2018. Published by Elsevier Inc.