Hemorrhagic stroke risk increased in older cirrhosis patients

Last Updated: 2017-06-06

By Anne Harding

NEW YORK (Reuters Health) - Older cirrhosis patients are at increased risk of stroke, especially hemorrhagic stroke, according to a new analysis of Medicare claims data published in JAMA Neurology.

“This is in contrast to what was previously thought about cirrhosis and stroke in general,” Dr. Neal S. Parikh of Weill Cornell Medicine in New York City, the study’s first author, told Reuters Health in a telephone interview. Physicians caring for patients with cirrhosis should control other stroke risk factors, such as hypertension, as aggressively as they would in patients without cirrhosis, he said.

In their study, published online June 5, Dr. Parikh and his team looked at inpatient and outpatient data for 2008-2015 for a random 5% sample of more than 1.6 million Medicare beneficiaries over 66 years old. One percent had cirrhosis.

During follow-up over a mean 4.3 years, 77,268 patients were hospitalized with stroke. Annual stroke incidence was 2.17% for the cirrhosis patients and 1.11% for those without cirrhosis. The hazard ratio (HR) for stroke in cirrhosis patients was 1.4, after accounting for demographic factors and stroke risk factors. The association was stronger with intracerebral hemorrhage (HR 1.9) and subarachnoid hemorrhage (HR 2.4) compared to ischemic stroke (HR 1.3). Decompensated cirrhosis was the type most strongly associated with stroke.

“It’s possible that our research will not generalize to younger patients with cirrhosis,” Dr. Parikh said.

He and his colleagues now plan to investigate whether cirrhosis is associated with intracranial aneurysms and rupture, and whether the elevated stroke risk in cirrhosis patients persists after liver transplant.

SOURCE: http://bit.ly/2ryvAtD

JAMA Neurology 2017.