Risk of Hemorrhagic Stroke in Asian American Ethnic Groups

Kaiser Permanente Medical Care Program, Oakland, CA 94611, USA.
Neuroepidemiology (Impact Factor: 2.56). 02/2005; 25(1):26-31. DOI: 10.1159/000085310
Source: PubMed


The sparseness of prospective data about hemorrhagic stroke (HS) risk among Asian American ethnic groups led to the investigation of 128,934 persons with self-classified ethnicity at health examinations in 1978-1985. Subsequently, 431 persons were hospitalized for HS; 31% for subarachnoid hemorrhage (SAH) and 69% for intracerebral hemorrhage (ICH). Ethnic predictors of HS were studied by Cox proportional hazard models with 7 covariates. With whites as reference, the adjusted relative risk (95% CI) of all Asians for HS was 1.6 (1.1-2.3, p = 0.01), due substantially to increased risks of SAH in Japanese people and ICH in Filipinos. These data mandate emphasis upon preventive measures in these groups.

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    • "First of all, it appears that Asians more often have cerebral small vessel disease, which is prone to bleeding. It has been shown that hemorrhagic stroke (intracerebral or subarachnoid hemorrhage), which accounts for 15% to 20% of strokes in whites,17 is more frequent among Asians.18 Death from hemorrhagic stroke is also much more common in Asians.19 "
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    ABSTRACT: Atrial fibrillation (AF) is an emerging epidemic in both high-income and low-income countries, mainly because of global population aging. Stroke is a major complication of AF, and AF-related ischemic stroke is more disabling and more fatal than other types of ischemic stroke. However, because of concerns about bleeding complications, particularly intracranial hemorrhage, and the limitations of a narrow therapeutic window, warfarin is underused. Four large phase III randomized controlled trials in patients with non-valvular AF (RE-LY, ROCKET-AF, ARISTOTLE, and ENGAGE-AF-TIMI 48) demonstrated that new oral anticoagulants (NOACs) are superior or non-inferior to warfarin as regards their efficacy in preventing ischemic stroke and systemic embolism, and superior to warfarin in terms of intracranial hemorrhage. Among AF patients receiving warfarin, Asians compared to non-Asians are at higher risk of stroke or systemic embolism and are also more prone to develop major bleeding complications, including intracranial hemorrhage. The extra benefit offered by NOACs over warfarin appears to be greater in Asians than in non-Asians. In addition, Asians are less compliant, partly because of the frequent use of herbal remedies. Therefore, NOACs compared to warfarin may be safer and more useful in Asians than in non-Asians, especially in stroke patients. Although the use of NOACs in AF patients is rapidly increasing, guidelines for the insurance reimbursement of NOACs have not been resolved, partly because of insufficient understanding of the benefit of NOACs and partly because of cost concerns. The cost-effectiveness of NOACs has been well demonstrated in the healthcare settings of developed countries, and its magnitude would vary depending on population characteristics as well as treatment cost. Therefore, academic societies and regulatory authorities should work together to formulate a scientific healthcare policy that will effectively reduce the burden of AF-related stroke in this rapidly aging society.
    05/2014; 16(2):73-80. DOI:10.5853/jos.2014.16.2.73
    • "Contrary to what is published, our patient did not have any of the known risk factors for ICH, such as maternal age >35, African American race, tobacco dependence, substance abuse, coagulopathy, or previous preeclampsia/eclampsia.[115] However, our patient was from India, and there are some reports indicating a higher incidence of hemorrhagic stroke in Asian women compared to Caucasian patients, most commonly occurring in the prepartum stage (58%).[14] "
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    ABSTRACT: Intracerebral hemorrhage is an infrequent but severe complication in pregnant women with hypertension. We describe an atypical case of a patient with no risk factors who developed sudden eclampsia and spontaneous intracerebral hemorrhage during the 34(th) week of pregnancy. She underwent successful emergent Cesarean section followed by craniotomy. Both intraoperative surveillance and postoperative magnetic resonance angiographic examination of the cerebral vessels failed to identify an aneurysm, arteriovenous malformation, tumor, or leptomeningeal disease. We discuss the management of this case and review the literature regarding the threshold for which initiation of antihypertensive treatment is indicated in pregnant patients.
    Surgical Neurology International 06/2012; 3(1):65. DOI:10.4103/2152-7806.97167 · 1.18 Impact Factor
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    • "Application of such strategies could be enhanced once the mortality predictors are identified. So far, different predictive models of mortality after stroke have been proposed from different countries [3] [4] [5] [6] [7] [8] indicating ethnic and racial variations in stroke outcome [9] [10] [11] [12] [13] [14]. Although data from many developing countries including some Arab countries regarding stroke have emerged in the past twenty years [15 – 17], there is a lack of such data from Palestine. "
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    ABSTRACT: The purpose of this study was to identify predictors of in-hospital mortality after acute stroke and investigate the impact of gender on stroke mortality. All patients admitted to Al-watani governmental hospital in Palestine from September 2006 to August 2007 and diagnosed with acute stroke were included in the study. Diagnosis of stroke was confirmed by computerized tomography scan. Demographics and clinical data pertaining to the patients were obtained from their medical files. The main outcome measure in this study was vital status at hospital discharge. Multiple logistic regression analysis was used to identify the independent predictors of in-hospital mortality. Statistical analysis was carried out using SPSS 15. A total of 186 acute stroke cases (95 females and 91 males) were included in the study. Hypertension (69.9%) and diabetes mellitus (45.2%) were the most common risk factors among the patients. Thirty nine (21%) of the stroke patients died in hospital. Multiple logistic regression analysis indicated that chronic kidney disease (P = 0.004), number of post-stroke complications (P = 0.037), and stroke subtype (P = 0.015) were independent predictors of in-hospital mortality among the total stroke patients. Knowledge of in-hospital mortality predictors is required to improve survival rate after acute stroke. The study showed that gender was not an independent predictor of mortality after acute stroke. More research is required to understand gender differences in stroke mortality.
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