Skip to main content
SpringerLink
Log in

Risk of thromboembolic complications after intracerebral hemorrhage according to ethnicity

  • Review
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Introduction

Incidence of thromboembolic (TE) disease varies with race and ethnicity yet little is known about whether these differences also apply to the poststroke period. We review the literature and compare published data with observations from two recent global trials on intracerebral hemorrhage (ICH).

Methods

A systematic review of the literature in EMBASE/Medline identified relevant articles. Published data were compared to the TE events—myocardial infarction (MI), cerebral infarction (CI), deep venous thrombosis (DVT), and pulmonary embolism (PE)—observed among placebo patients in two trials investigating the efficacy and safety of recombinant factor VIIa (rFVIIa) (Novo Nordisk A/S, Denmark) in the treatment of spontaneous ICH. The relative risk of TE complications after ICH was estimated for blacks/African Americans and Asians after adjustment for relevant risk factors.

Results

Only four relevant studies on TE disease after stroke were identified with data limited to poststroke MI and CI in a mixture of ischemic stroke and ICH patient populations. In the literature, blacks/African Americans appear to have a lower incidence rate of cardiac and cerebro-vascular complications after stroke, and Asians have a higher incidence rate of recurrent strokes, compared with Caucasians. In the two global trials, the overall poststroke incidence rates of MI, CI, DVT, and PE at 3 months after ICH onset were 2.3%, 2.0%, 3.7%, and 1.1%, respectively. After adjustment for differences in baseline risk factors, blacks/African Americans had a significantly higher risk of developing DVT compared with Caucasians (OR=5.64, P=0.0334), while Asians had a strong trend toward a higher risk of DVT (odds ratio=3.22, P=0.0932). The adjusted relative risk of PE, CI, and MI was not significantly different across ethnicities.

Conclusion

This is the first study to specifically examine the risk of TE complications in the post-ICH period according to ethnicity. In a limited ICH population, we observed a significantly higher risk of DVT in blacks/African Americans compared with Caucasians after adjustment for differences in risk factors. We observed nonsignificant trends toward differences in the relative risk of MI, CI, or PE across ethnicities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Leeder S, Raymond S, Greenberg H, Liu H, Esson K. A Race Against Time. The Challenge of Cardiovascular Disease in Developing Economies. The Trustees of Columbia University in the City of New York; 2004.

  2. World Health Organization. The Atlas of Heart Disease and Stroke. Mackay J, Mensah G, eds. Geneva: World Health Organization. 2004. Available at: www.who.int/cardiovascular_diseases/resources/atlas/en/index.html. Accessed March 14, 2007.

    Google Scholar 

  3. Woodward M, Huxley H, Lam TH. A comparison of the associations between risk factors and cardiovascular disease in Asia and Australasia. Eur J Cardiovasc Prev Rehabil. 2005;12:484–491.

    Article  PubMed  CAS  Google Scholar 

  4. US Department of Health and Human Services. Summary Health Statistics for US Adults: National Health Interview Survey, 2004. Vital Health Stat 10. 2006;228:18.

    Google Scholar 

  5. Kniffin WD Jr, Baron JA, Barrett J, Birkmeyer JD, Anderson FA Jr. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med. 1994;154: 861–866.

    Article  PubMed  Google Scholar 

  6. Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979–1998: an analysis using multiple-cause mortality data. Arch Intern Med. 2003;163:1711–1717.

    Article  PubMed  Google Scholar 

  7. White RH, Zhou H, Murin S, Harvey D. Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996. Thromb Haemost. 2005;93:298–305.

    PubMed  CAS  Google Scholar 

  8. Leung V, Leung V, Lui W, Chan T, Wong RS, Cheng G. Incidence of deep vein thrombosis in hospitalized Chinese medical patients is similar to that in western populations. Thromb Res. 2006;118: 763–764.

    Article  PubMed  CAS  Google Scholar 

  9. Mayer SA, Brun NC, Begtrup K, et al. Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med. 2005;352:777–785.

    Article  PubMed  CAS  Google Scholar 

  10. Mayer SA, Brun NC, Begtrup K, et al. Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med. 2008;358:2127–2137.

    Article  PubMed  CAS  Google Scholar 

  11. Lavados PM, Hennis AJM, Fernandes JG, et al. Stroke epidemiology, prevention, and management strategies at a regional level: Latin America and the Caribbean. Lancet Neurol. 2007;6:362–372.

    Article  PubMed  Google Scholar 

  12. Fustinoni O, Biller J. Ethnicity and stroke: beware of the fallacies. Stroke. 2000;31:1013–1015.

    PubMed  CAS  Google Scholar 

  13. Diringer MN, Skolnick BE, Mayer SA, et al. Risk of thromboembolic events in controlled trials of rFVIIa in spontaneous intracerebral hemorrhage. Stroke. 2008;39:850–856.

    Article  PubMed  CAS  Google Scholar 

  14. Brown DL, Lisabeth LD, Roychoudhury C, Ye Y, Morgenstern LB. Recurrent stroke risk is higher than cardiac event risk after initial stroke/transient ischemic attack. Stroke. 2005;36:1285–1287.

    Article  PubMed  Google Scholar 

  15. Ruland S, Richardson D, Hung E, et al. Predictors of recurrent stroke in African Americans. Neurology. 2006;67:567–571.

    Article  PubMed  CAS  Google Scholar 

  16. Chen ZM, Sandercock P, Pan HC, et al. Indications for early aspirin use in acute ischemic stroke: a combined analysis of 40 000 randomized patients from the Chinese acute stroke trial and the international stroke trial. Stroke. 2000;31:1240–1249.

    PubMed  CAS  Google Scholar 

  17. Thorvaldsen P, Asplund K, Kuulasmaa K, Rajakangas AM, Schroll M. Stroke incidence, case fatality, and mortality in the WHO MONICA project. World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease. Stroke. 1995;26:361–367.

    PubMed  CAS  Google Scholar 

  18. Woo KS, Tse LK, Tse CY, Metreweli C, Vallance-Owen J. The prevalence and pattern of pulmonary thromboembolism in the Chinese in Hong Kong. Int J Cardiol. 1988;20:373–380.

    Article  PubMed  CAS  Google Scholar 

  19. Stein PD, Kayali F, Olson RE. Regional differences in rates of diagnosis and mortality of pulmonary thromboembolism. Am J Cardiol. 2004;93:1194–1197.

    Article  PubMed  Google Scholar 

  20. White RH, Zhou H, Romano PS. Incidence of idiopathic deep venous thrombosis and secondary thromboembolism among ethnic groups in California. Ann Int Med. 1998;128:737–740.

    PubMed  CAS  Google Scholar 

  21. Bravata DM, Wells CK, Gulanski B, et al. Racial disparities in stroke risk factors: the impact of socioeconomic status. Stroke. 2005;36:1507–1511.

    Article  PubMed  Google Scholar 

  22. Patel RK, Ford E, Thumpston J, Arya R. Risk factors for venous thrombosis in the black population. Thromb Haemost. 2003;90:835–888.

    PubMed  CAS  Google Scholar 

  23. White H, Boden-Albala B, Wang C, et al. Ischemic stroke subtype incidence among whites, blacks and Hispanics. The Northern Manhattan Study. Circulation. 2005;111:1327–1331.

    Article  PubMed  Google Scholar 

  24. Stein PD, Huang H, Afzal A, Noor HA. Incidence of acute pulmonary embolism in a general hospital: relation to age, sex and race. Chest. 1999;116:909–913.

    Article  PubMed  Google Scholar 

  25. Broderick J, Brott T, Tomsick T, Miller R, Huster G. Intracerebral hemorrhage is more than twice as common as subarachnoid hemorrhage. J Neurosurg. 1993;78:188–191.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Global Development, Novo Nordisk A/S, Bagsvaerd, Denmark

    Michael C. Christensen & Catherine Vincent

  2. Acute Stroke Unit, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow, UK

    Jesse Dawson

Authors
  1. Michael C. Christensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jesse Dawson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Catherine Vincent
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael C. Christensen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Christensen, M.C., Dawson, J. & Vincent, C. Risk of thromboembolic complications after intracerebral hemorrhage according to ethnicity. Adv Therapy 25, 831–841 (2008). https://doi.org/10.1007/s12325-008-0092-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-008-0092-0

Keywords

Search

Navigation