From the Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (S.B.M., M.P., N.S.P., C.I., A.E.M., J.C., B.B.N., H.K.), Weill Cornell Medicine, New York, NY.
Department of Healthcare Policy and Research (X.W., I.D.), Weill Cornell Medicine, New York, NY.
Stroke. 2020 May;51(5):1464-1469. doi: 10.1161/STROKEAHA.119.028510. Epub 2020 Mar 17.
Background and Purpose- The risk of arterial ischemic events after subdural hemorrhage (SDH) is poorly understood. This study aimed to evaluate the risk of acute ischemic stroke and myocardial infarction among patients with and without nontraumatic SDH. Methods- We performed a retrospective cohort study using claims data from 2008 through 2014 from a nationally representative sample of Medicare beneficiaries. The exposure was nontraumatic SDH. Our primary outcome was an arterial ischemic event, a composite of acute ischemic stroke and acute myocardial infarction. Secondary outcomes were ischemic stroke alone and myocardial infarction alone. We used validated , , diagnosis codes to identify our predictor and outcomes. Using Cox regression and corresponding survival probabilities, adjusted for demographics and vascular comorbidities, we computed the hazard ratio in 4-week intervals after SDH discharge. We performed secondary analyses stratified by strong indications for antithrombotic therapy (composite of atrial fibrillation, peripheral vascular disease, valvular heart disease, and venous thromboembolism). Results- Among 1.7 million Medicare beneficiaries, 2939 were diagnosed with SDH. In the 4 weeks after SDH, patients' risk of an arterial ischemic event was substantially increased (hazard ratio, 3.6 [95% CI, 1.9-5.5]). There was no association between SDH diagnosis and arterial ischemic events beyond 4 weeks. In secondary analysis, during the 4 weeks after SDH, patients' risk of ischemic stroke was increased (hazard ratio, 4.2 [95% CI, 2.1-7.3]) but their risk of myocardial infarction was not (hazard ratio, 0.8 [95% CI, 0.2-1.7]). Patients with strong indications for antithrombotic therapy had increased risks for arterial ischemic events similar to patients in the primary analysis, but those without such indications did not demonstrate an increased risk for arterial ischemic events. Conclusions- Among Medicare beneficiaries, we found a heightened risk of arterial ischemic events driven by an increased risk of ischemic stroke, in the 4 weeks after nontraumatic SDH. This increased risk may be due to interruption of antithrombotic therapy after SDH diagnosis.
背景与目的- 硬膜下血肿（SDH）后发生动脉缺血性事件的风险尚不清楚。本研究旨在评估有无非创伤性 SDH 的患者发生急性缺血性卒中和心肌梗死的风险。
方法- 我们使用了来自 2008 年至 2014 年全国医疗保险受益人的索赔数据，进行了一项回顾性队列研究。暴露因素是非创伤性 SDH。我们的主要结局是动脉缺血性事件，包括急性缺血性卒中和急性心肌梗死。次要结局为单独的缺血性卒中和单独的心肌梗死。我们使用经过验证的、国际疾病分类、第 10 次修订版（ICD-10）诊断代码来识别我们的预测因子和结局。使用 Cox 回归和相应的生存概率，根据人口统计学和血管合并症进行调整，我们计算了 SDH 出院后 4 周的危险比。我们对有强烈抗血栓治疗指征（包括心房颤动、外周血管疾病、心脏瓣膜病和静脉血栓栓塞症）的患者进行了分层的二次分析。
结果- 在 170 万 Medicare 受益人中，有 2939 人被诊断为 SDH。在 SDH 后的 4 周内，患者发生动脉缺血性事件的风险显著增加（危险比，3.6 [95%CI，1.9-5.5]）。在 4 周后，SDH 诊断与动脉缺血性事件之间没有关联。在二次分析中，在 SDH 后的 4 周内，患者发生缺血性卒中和心肌梗死的风险均增加（危险比，4.2 [95%CI，2.1-7.3] 和 0.8 [95%CI，0.2-1.7]）。有强烈抗血栓治疗指征的患者发生动脉缺血性事件的风险与主要分析中的患者相似，但没有此类指征的患者动脉缺血性事件的风险没有增加。
结论- 在 Medicare 受益人中，我们发现非创伤性 SDH 后 4 周内，动脉缺血性事件的风险增加，这主要是由缺血性卒中风险增加引起的。这种风险增加可能是由于 SDH 诊断后抗血栓治疗的中断。
