Evolving patterns of intracranial hemorrhage in advanced therapies in patients with acute pulmonary embolism
Dissecting trends and contributing risk factors for intracranial hemorrhage (ICH) in patients treated for acute pulmonary embolism (PE) may allow for a better patient selection for existing and emerging treatment options. The German nationwide inpatient sample was screened for patients admitted due...
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| Veröffentlicht in: | Thrombosis research 2024-11, Vol.243, p.109168, Article 109168 |
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| creator | Christodoulou, Konstantinos C. Mohr, Katharina Uphaus, Timo Jägersberg, Max Valerio, Luca Farmakis, Ioannis T. Münzel, Thomas Lurz, Philipp Konstantinides, Stavros V. Hobohm, Lukas Keller, Karsten |
| description | Dissecting trends and contributing risk factors for intracranial hemorrhage (ICH) in patients treated for acute pulmonary embolism (PE) may allow for a better patient selection for existing and emerging treatment options.
The German nationwide inpatient sample was screened for patients admitted due to PE 2005–2020. Hospitalizations were stratified for the occurrence of ICH; risk factors for ICH and temporal trends were investigated.
Overall, 816,653 hospitalizations due to acute PE in the period 2005–2020 were analyzed in the study. ICH was reported in 2516 (0.3 %) hospitalizations, and time trend analysis revealed a fluctuating but overall, largely unchanged annual incidence. There was an increase of ICH with age. Patients with ICH had a higher comorbidity burden (Charlson-Comorbidity-Index [CCI], 5.0 [4.0–7.0] vs. 4.0 [2.0–5.0]; P |
| doi_str_mv | 10.1016/j.thromres.2024.109168 |
| format | Article |
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The German nationwide inpatient sample was screened for patients admitted due to PE 2005–2020. Hospitalizations were stratified for the occurrence of ICH; risk factors for ICH and temporal trends were investigated.
Overall, 816,653 hospitalizations due to acute PE in the period 2005–2020 were analyzed in the study. ICH was reported in 2516 (0.3 %) hospitalizations, and time trend analysis revealed a fluctuating but overall, largely unchanged annual incidence. There was an increase of ICH with age. Patients with ICH had a higher comorbidity burden (Charlson-Comorbidity-Index [CCI], 5.0 [4.0–7.0] vs. 4.0 [2.0–5.0]; P < 0.001), and higher CCI was associated with an OR of 1.26 (95%CI 1.24–1.27) for ICH. Further independent risk factors for ICH were age ≥ 70 years (OR 1.23 [1.12–1.34]), severe (versus low-risk) PE (OR 3.09 [2.84–3.35]), surgery (OR 1.59 [1.47–1.72]), acute kidney injury (OR 3.60 [3.09–4.18]), and ischemic stroke (OR 14.64 [12.61–17.00]). The identified risk factors for ICH varied among different reperfusion treatment groups. As expected, ICH had a substantial impact on case-fatality of PE (OR 6.16 [5.64–6.72]; P < 0.001).
Incidence of ICH in patients hospitalized for acute PE in Germany was overall low and depended on the patients' comorbidity burden. Identifying patients at risk for ICH allows tailored patient selection for the different reperfusion treatments and might prevent ICH.
•Incidence of intracranial hemorrhage (ICH) was low in patients with acute pulmonary embolism (PE).•Higher comorbidity burden was associated with increased ICH rate.•Older age, severe PE, surgery, kidney injury, and ischemic stroke were independent risk factors for ICH.•ICH had a substantial impact on case-fatality of PE.</description><identifier>ISSN: 0049-3848</identifier><identifier>ISSN: 1879-2472</identifier><identifier>EISSN: 1879-2472</identifier><identifier>DOI: 10.1016/j.thromres.2024.109168</identifier><identifier>PMID: 39326193</identifier><language>eng</language><publisher>United States: Elsevier Ltd</publisher><subject>Intracerebral bleeding ; Intracranial hemorrhage ; Pulmonary embolism ; Reperfusion treatment ; Thrombolysis</subject><ispartof>Thrombosis research, 2024-11, Vol.243, p.109168, Article 109168</ispartof><rights>2024 The Authors</rights><rights>Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c245t-fb72cb6d40dc318bd8d6fd0c8287171c7f2c1e841041b6fccd65a98f1fa737a83</cites><orcidid>0000-0002-0820-9584</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0049384824003001$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39326193$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Christodoulou, Konstantinos C.</creatorcontrib><creatorcontrib>Mohr, Katharina</creatorcontrib><creatorcontrib>Uphaus, Timo</creatorcontrib><creatorcontrib>Jägersberg, Max</creatorcontrib><creatorcontrib>Valerio, Luca</creatorcontrib><creatorcontrib>Farmakis, Ioannis T.</creatorcontrib><creatorcontrib>Münzel, Thomas</creatorcontrib><creatorcontrib>Lurz, Philipp</creatorcontrib><creatorcontrib>Konstantinides, Stavros V.</creatorcontrib><creatorcontrib>Hobohm, Lukas</creatorcontrib><creatorcontrib>Keller, Karsten</creatorcontrib><title>Evolving patterns of intracranial hemorrhage in advanced therapies in patients with acute pulmonary embolism</title><title>Thrombosis research</title><addtitle>Thromb Res</addtitle><description>Dissecting trends and contributing risk factors for intracranial hemorrhage (ICH) in patients treated for acute pulmonary embolism (PE) may allow for a better patient selection for existing and emerging treatment options.
The German nationwide inpatient sample was screened for patients admitted due to PE 2005–2020. Hospitalizations were stratified for the occurrence of ICH; risk factors for ICH and temporal trends were investigated.
Overall, 816,653 hospitalizations due to acute PE in the period 2005–2020 were analyzed in the study. ICH was reported in 2516 (0.3 %) hospitalizations, and time trend analysis revealed a fluctuating but overall, largely unchanged annual incidence. There was an increase of ICH with age. Patients with ICH had a higher comorbidity burden (Charlson-Comorbidity-Index [CCI], 5.0 [4.0–7.0] vs. 4.0 [2.0–5.0]; P < 0.001), and higher CCI was associated with an OR of 1.26 (95%CI 1.24–1.27) for ICH. Further independent risk factors for ICH were age ≥ 70 years (OR 1.23 [1.12–1.34]), severe (versus low-risk) PE (OR 3.09 [2.84–3.35]), surgery (OR 1.59 [1.47–1.72]), acute kidney injury (OR 3.60 [3.09–4.18]), and ischemic stroke (OR 14.64 [12.61–17.00]). The identified risk factors for ICH varied among different reperfusion treatment groups. As expected, ICH had a substantial impact on case-fatality of PE (OR 6.16 [5.64–6.72]; P < 0.001).
Incidence of ICH in patients hospitalized for acute PE in Germany was overall low and depended on the patients' comorbidity burden. Identifying patients at risk for ICH allows tailored patient selection for the different reperfusion treatments and might prevent ICH.
•Incidence of intracranial hemorrhage (ICH) was low in patients with acute pulmonary embolism (PE).•Higher comorbidity burden was associated with increased ICH rate.•Older age, severe PE, surgery, kidney injury, and ischemic stroke were independent risk factors for ICH.•ICH had a substantial impact on case-fatality of PE.</description><subject>Intracerebral bleeding</subject><subject>Intracranial hemorrhage</subject><subject>Pulmonary embolism</subject><subject>Reperfusion treatment</subject><subject>Thrombolysis</subject><issn>0049-3848</issn><issn>1879-2472</issn><issn>1879-2472</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNqFkEtPwzAQhC0EgvL4C8hHLil-pIlzAyFeUiUucLYce01cJXGwnSL-Pa4KXDmtNJrZ3fkQuqRkSQmtrjfL1AU_BIhLRliZxYZW4gAtqKibgpU1O0QLQsqm4KIUJ-g0xg0htKbN6hid8IazijZ8gfr7re-3bnzHk0oJwhixt9iNKSgd1OhUjzsYfAideoesY2W2atRgcOogqMlB3Kk57GBMEX-61GGl5wR4mvvBjyp8YRha37s4nKMjq_oIFz_zDL093L_ePRXrl8fnu9t1oVm5SoVta6bbypTEaE5Fa4SprCFaMFHnBrq2TFMQJSUlbSurtalWqhGWWlXzWgl-hq72e6fgP2aISQ4uauh7NYKfo-Q0RzMNTrK12lt18DEGsHIKbshPS0rkjrTcyF_Sckda7knn4OXPjbkdwPzFftFmw83eALnp1kGQUWdGGZ0LoJM03v134xuLj5X4</recordid><startdate>20241101</startdate><enddate>20241101</enddate><creator>Christodoulou, Konstantinos C.</creator><creator>Mohr, Katharina</creator><creator>Uphaus, Timo</creator><creator>Jägersberg, Max</creator><creator>Valerio, Luca</creator><creator>Farmakis, Ioannis T.</creator><creator>Münzel, Thomas</creator><creator>Lurz, Philipp</creator><creator>Konstantinides, Stavros V.</creator><creator>Hobohm, Lukas</creator><creator>Keller, Karsten</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0820-9584</orcidid></search><sort><creationdate>20241101</creationdate><title>Evolving patterns of intracranial hemorrhage in advanced therapies in patients with acute pulmonary embolism</title><author>Christodoulou, Konstantinos C. ; Mohr, Katharina ; Uphaus, Timo ; Jägersberg, Max ; Valerio, Luca ; Farmakis, Ioannis T. ; Münzel, Thomas ; Lurz, Philipp ; Konstantinides, Stavros V. ; Hobohm, Lukas ; Keller, Karsten</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c245t-fb72cb6d40dc318bd8d6fd0c8287171c7f2c1e841041b6fccd65a98f1fa737a83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Intracerebral bleeding</topic><topic>Intracranial hemorrhage</topic><topic>Pulmonary embolism</topic><topic>Reperfusion treatment</topic><topic>Thrombolysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Christodoulou, Konstantinos C.</creatorcontrib><creatorcontrib>Mohr, Katharina</creatorcontrib><creatorcontrib>Uphaus, Timo</creatorcontrib><creatorcontrib>Jägersberg, Max</creatorcontrib><creatorcontrib>Valerio, Luca</creatorcontrib><creatorcontrib>Farmakis, Ioannis T.</creatorcontrib><creatorcontrib>Münzel, Thomas</creatorcontrib><creatorcontrib>Lurz, Philipp</creatorcontrib><creatorcontrib>Konstantinides, Stavros V.</creatorcontrib><creatorcontrib>Hobohm, Lukas</creatorcontrib><creatorcontrib>Keller, Karsten</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Thrombosis research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Christodoulou, Konstantinos C.</au><au>Mohr, Katharina</au><au>Uphaus, Timo</au><au>Jägersberg, Max</au><au>Valerio, Luca</au><au>Farmakis, Ioannis T.</au><au>Münzel, Thomas</au><au>Lurz, Philipp</au><au>Konstantinides, Stavros V.</au><au>Hobohm, Lukas</au><au>Keller, Karsten</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evolving patterns of intracranial hemorrhage in advanced therapies in patients with acute pulmonary embolism</atitle><jtitle>Thrombosis research</jtitle><addtitle>Thromb Res</addtitle><date>2024-11-01</date><risdate>2024</risdate><volume>243</volume><spage>109168</spage><pages>109168-</pages><artnum>109168</artnum><issn>0049-3848</issn><issn>1879-2472</issn><eissn>1879-2472</eissn><abstract>Dissecting trends and contributing risk factors for intracranial hemorrhage (ICH) in patients treated for acute pulmonary embolism (PE) may allow for a better patient selection for existing and emerging treatment options.
The German nationwide inpatient sample was screened for patients admitted due to PE 2005–2020. Hospitalizations were stratified for the occurrence of ICH; risk factors for ICH and temporal trends were investigated.
Overall, 816,653 hospitalizations due to acute PE in the period 2005–2020 were analyzed in the study. ICH was reported in 2516 (0.3 %) hospitalizations, and time trend analysis revealed a fluctuating but overall, largely unchanged annual incidence. There was an increase of ICH with age. Patients with ICH had a higher comorbidity burden (Charlson-Comorbidity-Index [CCI], 5.0 [4.0–7.0] vs. 4.0 [2.0–5.0]; P < 0.001), and higher CCI was associated with an OR of 1.26 (95%CI 1.24–1.27) for ICH. Further independent risk factors for ICH were age ≥ 70 years (OR 1.23 [1.12–1.34]), severe (versus low-risk) PE (OR 3.09 [2.84–3.35]), surgery (OR 1.59 [1.47–1.72]), acute kidney injury (OR 3.60 [3.09–4.18]), and ischemic stroke (OR 14.64 [12.61–17.00]). The identified risk factors for ICH varied among different reperfusion treatment groups. As expected, ICH had a substantial impact on case-fatality of PE (OR 6.16 [5.64–6.72]; P < 0.001).
Incidence of ICH in patients hospitalized for acute PE in Germany was overall low and depended on the patients' comorbidity burden. Identifying patients at risk for ICH allows tailored patient selection for the different reperfusion treatments and might prevent ICH.
•Incidence of intracranial hemorrhage (ICH) was low in patients with acute pulmonary embolism (PE).•Higher comorbidity burden was associated with increased ICH rate.•Older age, severe PE, surgery, kidney injury, and ischemic stroke were independent risk factors for ICH.•ICH had a substantial impact on case-fatality of PE.</abstract><cop>United States</cop><pub>Elsevier Ltd</pub><pmid>39326193</pmid><doi>10.1016/j.thromres.2024.109168</doi><orcidid>https://orcid.org/0000-0002-0820-9584</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Intracerebral bleeding Intracranial hemorrhage Pulmonary embolism Reperfusion treatment Thrombolysis |
| title | Evolving patterns of intracranial hemorrhage in advanced therapies in patients with acute pulmonary embolism |
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