Advertisement

Prevention of Recurrent Intracerebral Hemorrhage

  • Chirantan Banerjee
  • Bruce Ovbiagele
Chapter

Abstract

The incidence of intracerebral hemorrhage (ICH) has remained unchanged in the last few decades and continues to carry high morbidity and mortality. However, limited data are available on the occurrence of recurrent ICH, in particular, how best to prevent it. Of note, survivors of an initial ICH are at elevated risk of both recurrent ICH and ischemic stroke, which necessitates that the potential benefits and hazards of antithrombotic (antiplatelet and anticoagulant) drugs be carefully considered in these high-risk patients. In view of the relative paucity of prospectively generated data, including dedicated clinical trials, current strategies for secondary prevention of ICH are primarily informed by retrospective analyses, as well as extrapolation from primary ICH and secondary stroke prevention studies. This review summarizes the current data on risk of ICH recurrence, risk factors associated with an increased risk of ICH recurrence, as well as management of antithrombotics, statins, and other modifiable risk factors in the context of avoiding recurrent ICH.

Keywords

Prevention Recurrent Intracerebral hemorrhage Antithrombotics Anticoagulants Antiplatelets Hypertension Amyloid angiopathy 

References

  1. 1.
    van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010;9(2):167–76.CrossRefPubMedGoogle Scholar
  2. 2.
    Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009;8(4):355–69.CrossRefPubMedGoogle Scholar
  3. 3.
    Poon MT, Fonville AF, Al-Shahi SR. Long-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2014;85(6):660–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Lovelock CE, Molyneux AJ, Rothwell PM. Change in incidence and aetiology of intracerebral haemorrhage in Oxfordshire, UK, between 1981 and 2006: a population-based study. Lancet Neurol. 2007;6(6):487–93.CrossRefPubMedGoogle Scholar
  5. 5.
    Bejot Y, Cordonnier C, Durier J, Aboa-Eboule C, Rouaud O, Giroud M. Intracerebral haemorrhage profiles are changing: results from the Dijon population-based study. Brain. 2013;136(Pt 2):658–64.CrossRefPubMedGoogle Scholar
  6. 6.
    Wani M, Nga E, Navaratnasingham R. Should a patient with primary intracerebral haemorrhage receive antiplatelet or anticoagulant therapy? BMJ. 2005;331(7514):439–42.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Hanger HC, Wilkinson TJ, Fayez-Iskander N, Sainsbury R. The risk of recurrent stroke after intracerebral haemorrhage. J Neurol Neurosurg Psychiatry. 2007;78(8):836–40.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Schmidt LB, Goertz S, Wohlfahrt J, Melbye M, Munch TN. Recurrent intracerebral hemorrhage: associations with comorbidities and medicine with antithrombotic effects. PLoS One. 2016;11(11):e0166223.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Weimar C, Benemann J, Terborg C, Walter U, Weber R, Diener HC. Recurrent stroke after lobar and deep intracerebral hemorrhage: a hospital-based cohort study. Cerebrovasc Dis. 2011;32(3):283–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Inagawa T. Recurrent primary intracerebral hemorrhage in Izumo City, Japan. Surg Neurol. 2005;64(1):28–35. discussion −6CrossRefPubMedGoogle Scholar
  11. 11.
    Passero S, Burgalassi L, D'Andrea P, Battistini N. Recurrence of bleeding in patients with primary intracerebral hemorrhage. Stroke. 1995;26(7):1189–92.CrossRefPubMedGoogle Scholar
  12. 12.
    Arakawa S, Saku Y, Ibayashi S, Nagao T, Fujishima M. Blood pressure control and recurrence of hypertensive brain hemorrhage. Stroke. 1998;29(9):1806–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Bae H, Jeong D, Doh J, Lee K, Yun I, Byun B. Recurrence of bleeding in patients with hypertensive intracerebral hemorrhage. Cerebrovasc Dis. 1999;9(2):102–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Hill MD, Silver FL, Austin PC, Tu JV. Rate of stroke recurrence in patients with primary intracerebral hemorrhage. Stroke. 2000;31(1):123–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Vermeer SE, Algra A, Franke CL, Koudstaal PJ, Rinkel GJ. Long-term prognosis after recovery from primary intracerebral hemorrhage. Neurology. 2002;59(2):205–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Cheung CM, Tsoi TH, Hon SF, Au-Yeung M, Shiu KL, Lee CN, et al. Outcomes after first-ever stroke. Hong Kong Med J. 2007;13(2):95–9.PubMedGoogle Scholar
  17. 17.
    Azarpazhooh MR, Nicol MB, Donnan GA, Dewey HM, Sturm JW, Macdonell RA, et al. Patterns of stroke recurrence according to subtype of first stroke event: the North East Melbourne Stroke Incidence Study (NEMESIS). Int J Stroke. 2008;3(3):158–64.CrossRefPubMedGoogle Scholar
  18. 18.
    Zia E, Engstrom G, Svensson PJ, Norrving B, Pessah-Rasmussen H. Three-year survival and stroke recurrence rates in patients with primary intracerebral hemorrhage. Stroke. 2009;40(11):3567–73.CrossRefPubMedGoogle Scholar
  19. 19.
    Izumihara A, Suzuki M, Ishihara T. Recurrence and extension of lobar hemorrhage related to cerebral amyloid angiopathy: multivariate analysis of clinical risk factors. Surg Neurol. 2005;64(2):160–4. discussion 4CrossRefPubMedGoogle Scholar
  20. 20.
    Biffi A, Halpin A, Towfighi A, Gilson A, Busl K, Rost N, et al. Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy. Neurology. 2010;75(8):693–8.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Yen CC, et al. Recurrent primary intracerebral hemorrhage: a hospital based study. Acta Neurol Taiwan. 2007;16(2):74–80.PubMedGoogle Scholar
  22. 22.
    O'Donnell HC, Rosand J, Knudsen KA, Furie KL, Segal AZ, Chiu RI, et al. Apolipoprotein E genotype and the risk of recurrent lobar intracerebral hemorrhage. N Engl J Med. 2000;342(4):240–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Charidimou A, Imaizumi T, Moulin S, Biffi A, Samarasekera N, Yakushiji Y, et al. Brain hemorrhage recurrence, small vessel disease type, and cerebral microbleeds: a meta-analysis. Neurology. 2017;89(8):820–9.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Huhtakangas J, Lopponen P, Tetri S, Juvela S, Saloheimo P, Bode MK, et al. Predictors for recurrent primary intracerebral hemorrhage: a retrospective population-based study. Stroke. 2013;44(3):585–90.CrossRefPubMedGoogle Scholar
  25. 25.
    Feldmann E, Broderick JP, Kernan WN, Viscoli CM, Brass LM, Brott T, et al. Major risk factors for intracerebral hemorrhage in the young are modifiable. Stroke. 2005;36(9):1881–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Woo D, Haverbusch M, Sekar P, Kissela B, Khoury J, Schneider A, et al. Effect of untreated hypertension on hemorrhagic stroke. Stroke. 2004;35(7):1703–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Thrift AG, McNeil JJ, Forbes A, Donnan GA. Three important subgroups of hypertensive persons at greater risk of intracerebral hemorrhage. Melbourne Risk Factor Study Group. Hypertension. 1998;31(6):1223–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Chapman N, Huxley R, Anderson C, Bousser MG, Chalmers J, Colman S, et al. Effects of a perindopril-based blood pressure-lowering regimen on the risk of recurrent stroke according to stroke subtype and medical history: the PROGRESS trial. Stroke. 2004;35(1):116–21.CrossRefPubMedGoogle Scholar
  29. 29.
    Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001;358(9287):1033–41.Google Scholar
  30. 30.
    Benavente OR, Coffey CS, Conwit R, Hart RG, McClure LA, Pearce LA, et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet. 2013;382(9891):507–15.CrossRefPubMedGoogle Scholar
  31. 31.
    Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke. 2007;38(6):2001–23.CrossRefPubMedGoogle Scholar
  32. 32.
    Biffi A, Anderson CD, Battey TW, Ayres AM, Greenberg SM, Viswanathan A, et al. Association between blood pressure control and risk of recurrent intracerebral hemorrhage. JAMA. 2015;314(9):904–12.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Protecting the brain after a bleed with home monitored blood pressure control 2016 [updated 2016-04-28]. Available from: https://www.stroke.org.uk/research/protecting-brain-after-bleed-home-monitored-blood-pressure-control.
  34. 34.
    Xu T, Zhang Y, Bu X, Wang D, Sun Y, Chen CS, et al. Blood pressure reduction in acute ischemic stroke according to time to treatment: a subgroup analysis of the China Antihypertensive Trial in Acute Ischemic Stroke trial. J Hypertens. 2017;35(6):1244–51.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Robinson TG, Potter JF, Ford GA, Bulpitt CJ, Chernova J, Jagger C, et al. Effects of antihypertensive treatment after acute stroke in the Continue or Stop Post-Stroke Antihypertensives Collaborative Study (COSSACS): a prospective, randomised, open, blinded-endpoint trial. Lancet Neurol. 2010;9(8):767–75.CrossRefPubMedGoogle Scholar
  36. 36.
    Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146(12):857–67.CrossRefPubMedGoogle Scholar
  37. 37.
    Gomez-Outes A, Lagunar-Ruiz J, Terleira-Fernandez AI, Calvo-Rojas G, Suarez-Gea ML, Vargas-Castrillon E. Causes of death in anticoagulated patients with atrial fibrillation. J Am Coll Cardiol. 2016;68(23):2508–21.CrossRefPubMedGoogle Scholar
  38. 38.
    Horstmann S, Rizos T, Lauseker M, Mohlenbruch M, Jenetzky E, Hacke W, et al. Intracerebral hemorrhage during anticoagulation with vitamin K antagonists: a consecutive observational study. J Neurol. 2013;260(8):2046–51.CrossRefPubMedGoogle Scholar
  39. 39.
    Falcone GJ, Biffi A, Brouwers HB, Anderson CD, Battey TW, Ayres AM, et al. Predictors of hematoma volume in deep and lobar supratentorial intracerebral hemorrhage. JAMA Neurol. 2013;70(8):988–94.CrossRefPubMedGoogle Scholar
  40. 40.
    Hanger HC, Fletcher VJ, Wilkinson TJ, Brown AJ, Frampton CM, Sainsbury R. Effect of aspirin and warfarin on early survival after intracerebral haemorrhage. J Neurol. 2008;255(3):347–52.CrossRefPubMedGoogle Scholar
  41. 41.
    Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955–62.CrossRefPubMedGoogle Scholar
  42. 42.
    Wilson D, Charidimou A, Shakeshaft C, Ambler G, White M, Cohen H, et al. Volume and functional outcome of intracerebral hemorrhage according to oral anticoagulant type. Neurology. 2016;86(4):360–6.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Hagii J, Tomita H, Metoki N, Saito S, Shiroto H, Hitomi H, et al. Characteristics of intracerebral hemorrhage during rivaroxaban treatment: comparison with those during warfarin. Stroke. 2014;45(9):2805–7.CrossRefPubMedGoogle Scholar
  44. 44.
    Nielsen PB, Larsen TB, Skjoth F, Lip GY. Outcomes associated with resuming warfarin treatment after hemorrhagic stroke or traumatic intracranial hemorrhage in patients with atrial fibrillation. JAMA Intern Med. 2017;177(4):563–70.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Murthy SB, Gupta A, Merkler AE, Navi BB, Mandava P, Iadecola C, et al. Restarting anticoagulant therapy after intracranial hemorrhage: a systematic review and meta-analysis. Stroke. 2017;48(6):1594–600.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Eckman MH, Rosand J, Knudsen KA, Singer DE, Greenberg SM. Can patients be anticoagulated after intracerebral hemorrhage? A decision analysis. Stroke. 2003;34(7):1710–6.CrossRefPubMedGoogle Scholar
  47. 47.
    Korompoki E, Filippidis FT, Nielsen PB, Del Giudice A, GYH L, Kuramatsu JB, et al. Long-term antithrombotic treatment in intracranial hemorrhage survivors with atrial fibrillation. Neurology. 2017;89(7):687–96.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Butler AC, Tait RC. Restarting anticoagulation in prosthetic heart valve patients after intracranial haemorrhage: a 2-year follow-up. Br J Haematol. 1998;103(4):1064–6.CrossRefPubMedGoogle Scholar
  49. 49.
    Ananthasubramaniam K, Beattie JN, Rosman HS, Jayam V, Borzak S. How safely and for how long can warfarin therapy be withheld in prosthetic heart valve patients hospitalized with a major hemorrhage? Chest. 2001;119(2):478–84.CrossRefPubMedGoogle Scholar
  50. 50.
    Majeed A, Kim YK, Roberts RS, Holmstrom M, Schulman S. Optimal timing of resumption of warfarin after intracranial hemorrhage. Stroke. 2010;41(12):2860–6.CrossRefPubMedGoogle Scholar
  51. 51.
    He J, Whelton PK, Vu B, Klag MJ. Aspirin and risk of hemorrhagic stroke: a meta-analysis of randomized controlled trials. JAMA. 1998;280(22):1930–5.CrossRefPubMedGoogle Scholar
  52. 52.
    Collaborative overview of randomised trials of antiplatelet therapy – I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists’ Collaboration. BMJ. 1994;308(6921):81–106.Google Scholar
  53. 53.
    Chong BH, Chan KH, Pong V, Lau KK, Chan YH, Zuo ML, et al. Use of aspirin in Chinese after recovery from primary intracranial haemorrhage. Thromb Haemost. 2012;107(2):241–7.CrossRefPubMedGoogle Scholar
  54. 54.
    Khan NI, Siddiqui FM, Goldstein JN, Cox M, Xian Y, Matsouaka RA, et al. Association between previous use of antiplatelet therapy and intracerebral hemorrhage outcomes. Stroke. 2017;48(7):1810–7.CrossRefPubMedGoogle Scholar
  55. 55.
    Sansing LH, Messe SR, Cucchiara BL, Cohen SN, Lyden PD, Kasner SE. Prior antiplatelet use does not affect hemorrhage growth or outcome after ICH. Neurology. 2009;72(16):1397–402.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Viswanathan A, Rakich SM, Engel C, Snider R, Rosand J, Greenberg SM, et al. Antiplatelet use after intracerebral hemorrhage. Neurology. 2006;66(2):206–9.CrossRefPubMedGoogle Scholar
  57. 57.
    Al-Shahi Salman R, Dennis MS. Antiplatelet therapy may be continued after intracerebral hemorrhage. Stroke. 2014;45(10):3149–50.CrossRefPubMedGoogle Scholar
  58. 58.
    Wang X, Dong Y, Qi X, Huang C, Hou L. Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis. Stroke. 2013;44(7):1833–9.CrossRefPubMedGoogle Scholar
  59. 59.
    Amarenco P, Bogousslavsky J, Callahan A 3rd, Goldstein LB, Hennerici M, Rudolph AE, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355(6):549–59.CrossRefPubMedGoogle Scholar
  60. 60.
    Goldstein LB, Amarenco P, Szarek M, Callahan A 3rd, Hennerici M, Sillesen H, et al. Hemorrhagic stroke in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels study. Neurology. 2008;70(24 Pt 2):2364–70.CrossRefPubMedGoogle Scholar
  61. 61.
    Collins R, Armitage J, Parish S, Sleight P, Peto R. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions. Lancet. 2004;363(9411):757–67.CrossRefPubMedGoogle Scholar
  62. 62.
    Westover MB, Bianchi MT, Eckman MH, Greenberg SM. Statin use following intracerebral hemorrhage: a decision analysis. Arch Neurol. 2011;68(5):573–9.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    McKinney JS, Kostis WJ. Statin therapy and the risk of intracerebral hemorrhage: a meta-analysis of 31 randomized controlled trials. Stroke. 2012;43(8):2149–56.CrossRefPubMedGoogle Scholar
  64. 64.
    Tapia-Perez JH, Rupa R, Zilke R, Gehring S, Voellger B, Schneider T. Continued statin therapy could improve the outcome after spontaneous intracerebral hemorrhage. Neurosurg Rev. 2013;36(2):279–87. discussion 87CrossRefPubMedGoogle Scholar
  65. 65.
    Tai SY, Lin FC, Lee CY, Chang CJ, Wu MT, Chien CY. Statin use after intracerebral hemorrhage: a 10-year nationwide cohort study. Brain Behav. 2016;6(8):e00487.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Khan A, Patel NK, O'Hearn DJ, Khan S. Resistant hypertension and obstructive sleep apnea. Int J Hypertens. 2013;2013:193010.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Pontes-Neto OM, Fernandes RM, Sander HH, da Silva LA, Mariano DC, Nobre F, et al. Obstructive sleep apnea is frequent in patients with hypertensive intracerebral hemorrhage and is related to perihematoma edema. Cerebrovasc Dis. 2010;29(1):36–42.CrossRefPubMedGoogle Scholar
  68. 68.
    Thrift AG, Donnan GA, McNeil JJ. Heavy drinking, but not moderate or intermediate drinking, increases the risk of intracerebral hemorrhage. Epidemiology. 1999;10(3):307–12.CrossRefPubMedGoogle Scholar
  69. 69.
    Iso H, Baba S, Mannami T, Sasaki S, Okada K, Konishi M, et al. Alcohol consumption and risk of stroke among middle-aged men: the JPHC Study Cohort I. Stroke. 2004;35(5):1124–9.CrossRefPubMedGoogle Scholar
  70. 70.
    O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376(9735):112–23.CrossRefPubMedGoogle Scholar
  71. 71.
    Ariesen MJ, Claus SP, Rinkel GJ, Algra A. Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke. 2003;34(8):2060–5.CrossRefPubMedGoogle Scholar
  72. 72.
    Kurth T, Kase CS, Berger K, Gaziano JM, Cook NR, Buring JE. Smoking and risk of hemorrhagic stroke in women. Stroke. 2003;34(12):2792–5.CrossRefPubMedGoogle Scholar
  73. 73.
    Kurth T, Kase CS, Berger K, Schaeffner ES, Buring JE, Gaziano JM. Smoking and the risk of hemorrhagic stroke in men. Stroke. 2003;34(5):1151–5.CrossRefPubMedGoogle Scholar
  74. 74.
    Gee P, Tallon C, Long N, Moore G, Boet R, Jackson S. Use of recreational drug 1,3 Dimethylamylamine (DMAA) [corrected] associated with cerebral hemorrhage. Ann Emerg Med. 2012;60(4):431–4.CrossRefPubMedGoogle Scholar
  75. 75.
    Aggarwal SK, Williams V, Levine SR, Cassin BJ, Garcia JH. Cocaine-associated intracranial hemorrhage: absence of vasculitis in 14 cases. Neurology. 1996;46(6):1741–3.CrossRefPubMedGoogle Scholar
  76. 76.
    Pozzi M, Roccatagliata D, Sterzi R. Drug abuse and intracranial hemorrhage. Neurol Sci. 2008;29(Suppl 2):S269–70.CrossRefPubMedGoogle Scholar
  77. 77.
    Woo D, Sauerbeck LR, Kissela BM, Khoury JC, Szaflarski JP, Gebel J, et al. Genetic and environmental risk factors for intracerebral hemorrhage: preliminary results of a population-based study. Stroke. 2002;33(5):1190–5.CrossRefPubMedGoogle Scholar
  78. 78.
    Zhang Y, Tuomilehto J, Jousilahti P, Wang Y, Antikainen R, Hu G. Lifestyle factors on the risks of ischemic and hemorrhagic stroke. Arch Intern Med. 2011;171(20):1811–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurologyMedical University of South CarolinaCharlestonUSA
  2. 2.University of California, San Francisco Medical CenterSan FranciscoUSA

Personalised recommendations