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Anemia triples risk for death after stroke

Issue: April 2012

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International Stroke Conference 2012

NEW ORLEANS — After a stroke, patients with severe anemia were 3.5 times more likely to die while in the hospital and 2.5 times more likely to die within 1 year compared with stroke survivors who were not anemic, researchers reported here.

To examine the link between mortality and anemia after a stroke, researchers reviewed the medical records for 3,750 male veterans who were admitted for a confirmed diagnosis of first ischemic stroke in 2007. All patients were cared for at 131 Veterans Health Administration facilities. Hematocrit values from 24 hours of admission were categorized into six tiers: severe anemia, 27% or less; moderate anemia, 28% to 32%; mild anemia, 33% to 37%; normal, 38% to 42%; normal, 43% to 47%; and polycythemia at least 48%. Most patients were healthy (64.6%), 17.9% had mild anemia, 9.1% had polycythemia, 6.2% had moderate anemia and 2.1% had severe anemia.

“Lower and higher hematocrits were associated with poorer outcomes after controlling for medical comorbidities and stroke severity,” Jason J. Sico, MD, assistant professor of neurology at Yale University School of Medicine, said at a press conference.

For patients with hematocrit values of 27% or less, mortality in the hospital (OR=3.46; 95% CI, 1.30-9.22), at 30 days (OR=2.47; 95% CI, 1.21-5.05), at 6 months (OR=2.54; 95% CI, 1.39-4.63) and at 1 year (OR=2.58; 95% CI, 1.46-4.55) was 2.5 to 3.5 times higher. Mild anemia (OR=1.42; 95% CI, 1.06-1.91 and OR=1.30; 95% CI, 1.00-1.70) and moderate anemia (OR=2.19; 95% CI, 1.49-3.23 and OR=2.05; 95% CI, 1.43-2.95) were associated with higher 6-month and 1-year mortality, respectively. Researchers found an independent association with high hematocrit values and in-hospital mortality only (HR=2.89; 95% CI, 1.39-6.00) and only in those with levels at least 48%.

Even those who are slightly anemic should be aware of the increased risk for death after stroke, the researchers said. At the press conference, Sico recommended evaluation for potentially reversible causes of anemia and polycythemia in stroke patients and closer monitoring of anemic patients after stroke.

Future research will focus on which types of anemia are associated with higher risks for mortality and the effect of anemia on women after a stroke. The researchers said additional study is required to evaluate whether interventions that treat anemia may also reduce mortality after stroke. Hematocrit augmentation strategies cannot be recommended at this time, Sico said. – by Katie Kalvaitis

For more information:

• Sico JJ. Abstract #147. Presented at: the American Stroke Association’s International Stroke Conference 2012; Feb. 1-3, 2012; New Orleans.

Disclosure: Dr. Sico reports no relevant financial disclosures.

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