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Medication intake and hemorrhage risk in patients with familial cerebral cavernous malformations
Alejandro N Santos1, Laurèl Rauschenbach1, Dino Saban1
11Department of Neurosurgery and Spine Surgery, University Hospital Essen.
Insights
Intracerebral hemorrhage (ICH) predicts recurrent bleeding in familial cerebral cavernous malformation (FCCM). Statins and antithrombotics may reduce hemorrhage risk, though further research is needed.
Area of Science:
- Neurology
- Genetics
- Vascular Medicine
Background:
- Familial cerebral cavernous malformation (FCCM) is a genetic disorder characterized by vascular malformations in the brain.
- Hemorrhage is a major complication of FCCM, leading to significant morbidity and mortality.
Purpose of the Study:
- To investigate the impact of medication use on the risk of intracerebral hemorrhage (ICH) in patients with FCCM.
- To identify predictors of recurrent hemorrhage in this patient population.
Main Methods:
- Retrospective analysis of a database of FCCM patients (2003-2020).
- Inclusion criteria: complete MRI, multiple CCMs, baseline data, and follow-up.
- Statistical analysis included logistic regression, Kaplan-Meier, and Cox regression, adjusting for age and sex.
Main Results:
- Intracerebral hemorrhage (ICH) at diagnosis was a significant predictor of recurrent hemorrhage.
- A trend towards decreased ICH risk was observed in patients taking statin medication (HR 0.22, p=0.143).
- No bleeding events occurred in patients on antithrombotic therapy; a trend towards lower ICH risk was noted (p=0.085).
Conclusions:
- ICH is a key risk factor for recurrent bleeding in FCCM patients.
- Statin and antithrombotic medications showed a potential trend towards reducing hemorrhage risk, warranting further investigation.
Objective:
The objective of this study was to analyze the impact of medication intake on hemorrhage risk in patients with familial cerebral cavernous malformation (FCCM).
Methods:
The authors' institutional database was screened for patients with FCCM who had been admitted to their department between 2003 and 2020. Patients with a complete magnetic resonance imaging (MRI) data set, evidence of multiple CCMs, clinical baseline characteristics, and follow-up (FU) examination were included in the study. The authors assessed the influence of medication intake on first or recurrent intracerebral hemorrhage (ICH) using univariate and multivariate logistic regression adjusted for age and sex. The longitudinal cumulative 5-year risk of hemorrhage was calculated by applying Kaplan-Meier and Cox regression analyses adjusted for age and sex.
Results:
Two hundred five patients with FCCMs were included in the study. Multivariate Cox regression analysis revealed ICH as a predictor for recurrent hemorrhage during the 5-year FU. The authors also noted a tendency toward a decreased association with ICH during FU in patients on statin medication (HR 0.22, 95% CI 0.03-1.68, p = 0.143), although the relationship was not statistically significant. No bleeding events were observed in patients on antithrombotic therapy. Kaplan-Meier analysis and log-rank test showed a tendency toward a low risk of ICH during FU in patients on antithrombotic therapy (p = 0.085), as well as those on statin therapy (p = 0.193). The cumulative 5-year risk of bleeding was 22.82% (95% CI 17.33%-29.38%) for the entire cohort, 31.41% (95% CI 23.26%-40.83%) for patients with a history of ICH, 26.54% (95% CI 11.13%-49.7%) for individuals on beta-blocker medication, 6.25% (95% CI 0.33%-32.29%) for patients on statin medication, and 0% (95% CI 0%-30.13%) for patients on antithrombotic medication.
Conclusions:
ICH at diagnosis was identified as a risk factor for recurrent hemorrhage. Although the relationships were not statistically significant, statin and antithrombotic medication tended to be associated with decreased bleeding events.
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