Cirrhosis Associated With Increased Stroke Risk

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The increased risk of stroke in patients with cirrhosis may be due to a mixed coagulopathy.
The increased risk of stroke in patients with cirrhosis may be due to a mixed coagulopathy.

A cirrhosis diagnosis was tied to an increased risk for stroke, especially hemorrhagic stroke, in a cohort of Medicare beneficiaries, according to research published in JAMA Neurology.

Cirrhosis is tied to thrombotic and hemorrhagic risks outside of the hepatic system, including venous thromboembolism and gastrointestinal bleeding. However, there is limited understanding of the cerebrovascular risks associated with cirrhosis.

Neal S. Parikh, MD, of the department of neurology at Weill Cornell Medical College in New York, New York and colleagues sought to better understand the relationship between cirrhosis and cerebrovascular complications in a cohort of Medicare beneficiaries.

The investigators conducted a retrospective cohort study of 1,618,059 Medicare beneficiaries from January 2008 to December 2014. Patients with cirrhosis were identified using a diagnosis code algorithm and followed for a primary outcome of hospitalization for stroke.

Within the cohort, 15,586 patients (1.0%), mean age 74.1, were identified as having a cirrhosis diagnosis. Patients with cirrhosis were more often men and had more stroke risk factors. Over a mean follow-up of 4.3 years, 77,268 patients in the cohort were hospitalized with a stroke diagnosis.

Patients with cirrhosis had a 2.17% per year incidence of stroke compared with 1.11% per year incidence of stroke in patients without a cirrhosis diagnosis. The annual incidence of ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage in patients with cirrhosis was 1.80%, 0.31%, and 0.13%, respectively. This was compared with an annual incidence of ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage in patients without cirrhosis of 0.96%, 0.14%, and 0.04%, respectively.

After adjusting for demographics, comorbidities, and stroke risk, cirrhosis was associated with a higher risk for any stroke (hazard ratio [HR] 1.4), but there was a slightly higher risk for intracranial hemorrhage (HR 1.9) and subarachnoid hemorrhage (HR 2.4) than ischemic stroke (HR 1.3).

The increased risk of stroke in patients with cirrhosis may be due to a mixed coagulopathy, and the bleeding risk is possibly independent of portal hypertension, the investigators suggest.

“In a nationally representative sample of elderly patients with vascular risk factors, cirrhosis was associated with an increased risk of stroke, particularly hemorrhagic stroke,” the investigators concluded.


Reference

Parikh NS, Navi BB, Schneider Y, Jesudian A, Kamel H. Association between cirrhosis and stroke in a nationally representative cohort [published online June 5, 2017]. JAMA Neurol. doi:10.1001/jamaneurol.2017.0923

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