Recurrent brain hemorrhage is more frequent than ischemic stroke after intracranial hemorrhage
Recurrent brain hemorrhage is more frequent than ischemic stroke after intracranial hemorrhage
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DOI：
10.1212/wnl.56.6.773
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发表时间：
2001-03-27
期刊：
影响因子：
9.9
通讯作者：
Pearce, LA
中科院分区：
文献类型：
--
作者：
Bailey, RD;Hart, RG;Pearce, LA
目的：研究原发性ICE存活者再发颅内出血(ICH)、缺血性卒中和死亡的发生率。方法：系统回顾关于原发性脑出血存活者再发卒中的研究，以脑出血指数确定，并进行后续追踪。通过文献的计算机搜索和参考文献列表的审查来确定研究。结果：1982至2000年间发表的10项研究报告了1,880名脑出血幸存者，共随访6,326个病人年(平均随访3.4个病人年)。来自五项研究的所有中风的总发生率为4.3%/患者年(95%可信区间，3.5%至5.4%)。三项基于人群的研究的发病率高于两项基于医院的研究，分别为6.2%和4.0%(p=0.04)。大约四分之三的复发中风是脑出血。考虑到所有10项研究，共有147名患者有脑出血复发，每患者年的总发生率为2.3%(95%CI，1.9%至2.7%)。根据四项研究的数据，原发性大叶性脑出血患者的复发率高于深部半球脑出血患者(4.4%对2.1%/病人年；p=0.002)。随后的缺血性卒中和死亡率分别为1.1%/患者年(95%CI，0.8%~1.7%)和8.8%/患者年(95%CI，5.2%~11.0%)。结论：在原发性脑出血的幸存者中，再发卒中的发生率约为4%/病人年，并且大多数是再发脑出血。脑出血幸存者发生脑出血复发的风险高于缺血性卒中，这对这些患者使用抗血栓药物有一定的指导意义。
Objective: To characterize the rates of recurrent intracranial hemorrhage (ICH), ischemic stroke, and death in survivors of primary ICE. Methods: Systematic review of studies reporting recurrent stroke in survivors of primary ICH, identified at index ICH and followed forward. Studies were identified by computerized search of the literature and review of reference lists. Results: Ten studies published between 1982 and 2000 reporting 1,880 survivors of ICH, followed for a total of 6,326 patient-years (mean follow-up, 3.4 patient-years), were included. The aggregate rate of all stroke from five studies was 4.3% per patient-year (95% CI, 3.5% to 5.4%). The rate in the three population-based studies was higher than in the two hospital-based studies, 6.2% versus 4.0% per patient-year (p = 0.04). About three fourths of recurrent strokes were ICH. Considering all 10 studies, a total of 147 patients had a recurrent ICH, an aggregate rate of 2.3% per patient-year (95% CI, 1.9% to 2.7%). Based on data from four studies, patients with a primary lobar ICH had a higher rate of recurrent ICH than those with a deep, hemispheric ICH (4.4% versus 2.1% per patient-year; p = 0.002). The aggregate rates of subsequent ischemic stroke and mortality were 1.1% per patient-year (95% CI, 0.8% to 1.7%) and 8.8% per patient-year (95% CI, 5.2% to 11.0%). Conclusions: Recurrent stroke among survivors of primary ICH occurs at a rate of about 4% per patient-year, and most are recurrent ICH. Survivors of ICH have a higher risk of recurrent ICH than of ischemic stroke, and this has implications for the use of antithrombotic agents in these patients.