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Cirrhosis associated with increased risk for stroke, hemorrhagic stroke

Recently published data showed an association between cirrhosis and an increased risk for stroke, particularly hemorrhagic stroke, which may be related to mixed coagulopathy observed in cirrhosis.

“Cirrhosis is associated with extrahepatic hemorrhagic and thrombotic processes, such as gastrointestinal bleeding and venous thromboembolism. The cerebrovascular complications of cirrhosis are comparatively less well understood,” Neal S. Parikh, MD, from the Department of Neurology, Weill Cornell Medicine, New York, and colleagues wrote. “Because of the continued uncertainty, we sought to assess the association between cirrhosis and various stroke types in a large, nationally representative sample of Medicare beneficiaries.”

The retrospective study comprised data from 1,618,059 Medicare beneficiaries’ claims from Jan. 1, 2008, to Dec. 31, 2014. The associations with cirrhosis included stroke, ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage.

Overall, 77,268 patients were hospitalized with stroke during a mean follow-up of 4.3 years (incidence rate = 2.17%; 95% CI, 1.99-2.36). Compared with the rest of the population, more of these patients were women (58.5% vs. 57.2%) and had higher rates of stroke risk factors, such as diabetes, cardiovascular complications, kidney disease, alcohol use and tobacco use.

In total, 15,586 patients had cirrhosis. Mean patient age of those with cirrhosis was 74.1 years and 7,263 were women. Compared with patients without cirrhosis, those with cirrhosis were more frequently men (53.3% vs. 42.6%) and had higher rates of stroke risk factors.

For those with cirrhosis, the researchers verified the annual incidence rates of stroke (IR = 2.7%; 95% CI, 1.99-2.36), ischemic stroke (IR = 1.8%; 95% CI, 1.64-1.98), intracerebral hemorrhage (IR = 0.31%; 95% CI, 0.25-0.39) and subarachnoid hemorrhage (IR = 0.13%; 95% CI, 0.09-0.18).

Among patients without cirrhosis, the annual incidence rates were lower for stroke (IR = 1.11%; 95% CI, 1.10-1.11), ischemic stroke (IR = 0.96%; 95% CI, 0.96-0.97), intracerebral hemorrhage (0.14%; 95% CI, 0.13-0.14) and subarachnoid hemorrhage (IR = 0.04%; 95% CI, 0.04-0.05).

“We found that patients with cirrhosis faced an increased risk of stroke after adjustment for patient demographic characteristics, traditional stroke risk factors, and relevant comorbidities,” the researchers concluded. “Cirrhosis appeared to be more strongly associated with hemorrhagic stroke than ischemic stroke. Similar associations were seen regardless of cirrhosis type, although decompensated cirrhosis appeared to have the strongest association with stroke.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.