Prognostic significance of delayed intraventricular haemorrhage in the INTERACT studies

Tom J. Moullaali, Shoichiro Sato, Xia Wang, Alejandro Rabinstein, Hisatomi Arima, Cheryl Carcel, Guofang Chen, Thompson Robinson, Emma Heeley, Edward Chan, Candice Delcourt, Christian Stapf, Charlotte Cordonnier, Richard I. Lindley, John Chalmers, Craig S. Anderson

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Abstract

Background and purpose Intraventricular extension of intracerebral haemorrhage (ICH) predicts poor outcome, but the significance of delayed intraventricular haemorrhage (dIVH) is less well defined. We determined the prognostic significance of dIVH in the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trials (INTERACT 1 and 2). Methods Pooled analyses of the INTERACT CT substudies - international, multicentre, prospective, open, blinded end point, randomised controlled trials of patients with acute spontaneous ICH and elevated systolic blood pressure (SBP) - randomly assigned to intensive (<140 mm Hg) or guideline-based (<180 mm Hg) SBP management. Participants had blinded central analyses of baseline and 24 h CTs, with dIVH defined as new intraventricular haemorrhage (IVH) on the latter scan. Outcomes of death and major disability were defined by modified Rankin Scale scores at 90 days. Results There were 349 (27%) of 1310 patients with baseline IVH, and 107 (11%) of 961 initially IVH-free patients who developed dIVH. Significant associations of dIVH were prior warfarin anticoagulation, high (≥15) baseline National Institutes of Health Stroke Scale score, larger (≥15 mL) ICH volume, greater ICH growth and higher achieved SBP over 24 h. Compared with those who were IVH-free, dIVH had greater odds of 90-day death or major disability versus initial IVH (adjusted ORs 2.84 (95% CI 1.52 to 5.28) and 1.87 (1.36 to 2.56), respectively (p trend <0.0001)). Conclusions Although linked to factors determining greater ICH growth including poor SBP control, dIVH is independently associated with poor outcome in acute small to moderate-size ICH. Trial registration numbers NCT00226096 and NCT00716079.

Original languageEnglish (US)
Pages (from-to)19-24
Number of pages6
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume88
Issue number1
DOIs
StatePublished - Jan 1 2017

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Hemorrhage
Cerebral Hemorrhage
Blood Pressure
National Institutes of Health (U.S.)
Warfarin
Growth
Randomized Controlled Trials
Stroke
Guidelines

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

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Prognostic significance of delayed intraventricular haemorrhage in the INTERACT studies. / Moullaali, Tom J.; Sato, Shoichiro; Wang, Xia; Rabinstein, Alejandro; Arima, Hisatomi; Carcel, Cheryl; Chen, Guofang; Robinson, Thompson; Heeley, Emma; Chan, Edward; Delcourt, Candice; Stapf, Christian; Cordonnier, Charlotte; Lindley, Richard I.; Chalmers, John; Anderson, Craig S.

In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 88, No. 1, 01.01.2017, p. 19-24.

Research output: Contribution to journalArticle

Moullaali, TJ, Sato, S, Wang, X, Rabinstein, A, Arima, H, Carcel, C, Chen, G, Robinson, T, Heeley, E, Chan, E, Delcourt, C, Stapf, C, Cordonnier, C, Lindley, RI, Chalmers, J & Anderson, CS 2017, 'Prognostic significance of delayed intraventricular haemorrhage in the INTERACT studies', Journal of Neurology, Neurosurgery and Psychiatry, vol. 88, no. 1, pp. 19-24. https://doi.org/10.1136/jnnp-2015-311562
Moullaali, Tom J. ; Sato, Shoichiro ; Wang, Xia ; Rabinstein, Alejandro ; Arima, Hisatomi ; Carcel, Cheryl ; Chen, Guofang ; Robinson, Thompson ; Heeley, Emma ; Chan, Edward ; Delcourt, Candice ; Stapf, Christian ; Cordonnier, Charlotte ; Lindley, Richard I. ; Chalmers, John ; Anderson, Craig S. / Prognostic significance of delayed intraventricular haemorrhage in the INTERACT studies. In: Journal of Neurology, Neurosurgery and Psychiatry. 2017 ; Vol. 88, No. 1. pp. 19-24.
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abstract = "Background and purpose Intraventricular extension of intracerebral haemorrhage (ICH) predicts poor outcome, but the significance of delayed intraventricular haemorrhage (dIVH) is less well defined. We determined the prognostic significance of dIVH in the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trials (INTERACT 1 and 2). Methods Pooled analyses of the INTERACT CT substudies - international, multicentre, prospective, open, blinded end point, randomised controlled trials of patients with acute spontaneous ICH and elevated systolic blood pressure (SBP) - randomly assigned to intensive (<140 mm Hg) or guideline-based (<180 mm Hg) SBP management. Participants had blinded central analyses of baseline and 24 h CTs, with dIVH defined as new intraventricular haemorrhage (IVH) on the latter scan. Outcomes of death and major disability were defined by modified Rankin Scale scores at 90 days. Results There were 349 (27{\%}) of 1310 patients with baseline IVH, and 107 (11{\%}) of 961 initially IVH-free patients who developed dIVH. Significant associations of dIVH were prior warfarin anticoagulation, high (≥15) baseline National Institutes of Health Stroke Scale score, larger (≥15 mL) ICH volume, greater ICH growth and higher achieved SBP over 24 h. Compared with those who were IVH-free, dIVH had greater odds of 90-day death or major disability versus initial IVH (adjusted ORs 2.84 (95{\%} CI 1.52 to 5.28) and 1.87 (1.36 to 2.56), respectively (p trend <0.0001)). Conclusions Although linked to factors determining greater ICH growth including poor SBP control, dIVH is independently associated with poor outcome in acute small to moderate-size ICH. Trial registration numbers NCT00226096 and NCT00716079.",
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AU - Sato, Shoichiro

AU - Wang, Xia

AU - Rabinstein, Alejandro

AU - Arima, Hisatomi

AU - Carcel, Cheryl

AU - Chen, Guofang

AU - Robinson, Thompson

AU - Heeley, Emma

AU - Chan, Edward

AU - Delcourt, Candice

AU - Stapf, Christian

AU - Cordonnier, Charlotte

AU - Lindley, Richard I.

AU - Chalmers, John

AU - Anderson, Craig S.

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N2 - Background and purpose Intraventricular extension of intracerebral haemorrhage (ICH) predicts poor outcome, but the significance of delayed intraventricular haemorrhage (dIVH) is less well defined. We determined the prognostic significance of dIVH in the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trials (INTERACT 1 and 2). Methods Pooled analyses of the INTERACT CT substudies - international, multicentre, prospective, open, blinded end point, randomised controlled trials of patients with acute spontaneous ICH and elevated systolic blood pressure (SBP) - randomly assigned to intensive (<140 mm Hg) or guideline-based (<180 mm Hg) SBP management. Participants had blinded central analyses of baseline and 24 h CTs, with dIVH defined as new intraventricular haemorrhage (IVH) on the latter scan. Outcomes of death and major disability were defined by modified Rankin Scale scores at 90 days. Results There were 349 (27%) of 1310 patients with baseline IVH, and 107 (11%) of 961 initially IVH-free patients who developed dIVH. Significant associations of dIVH were prior warfarin anticoagulation, high (≥15) baseline National Institutes of Health Stroke Scale score, larger (≥15 mL) ICH volume, greater ICH growth and higher achieved SBP over 24 h. Compared with those who were IVH-free, dIVH had greater odds of 90-day death or major disability versus initial IVH (adjusted ORs 2.84 (95% CI 1.52 to 5.28) and 1.87 (1.36 to 2.56), respectively (p trend <0.0001)). Conclusions Although linked to factors determining greater ICH growth including poor SBP control, dIVH is independently associated with poor outcome in acute small to moderate-size ICH. Trial registration numbers NCT00226096 and NCT00716079.

AB - Background and purpose Intraventricular extension of intracerebral haemorrhage (ICH) predicts poor outcome, but the significance of delayed intraventricular haemorrhage (dIVH) is less well defined. We determined the prognostic significance of dIVH in the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trials (INTERACT 1 and 2). Methods Pooled analyses of the INTERACT CT substudies - international, multicentre, prospective, open, blinded end point, randomised controlled trials of patients with acute spontaneous ICH and elevated systolic blood pressure (SBP) - randomly assigned to intensive (<140 mm Hg) or guideline-based (<180 mm Hg) SBP management. Participants had blinded central analyses of baseline and 24 h CTs, with dIVH defined as new intraventricular haemorrhage (IVH) on the latter scan. Outcomes of death and major disability were defined by modified Rankin Scale scores at 90 days. Results There were 349 (27%) of 1310 patients with baseline IVH, and 107 (11%) of 961 initially IVH-free patients who developed dIVH. Significant associations of dIVH were prior warfarin anticoagulation, high (≥15) baseline National Institutes of Health Stroke Scale score, larger (≥15 mL) ICH volume, greater ICH growth and higher achieved SBP over 24 h. Compared with those who were IVH-free, dIVH had greater odds of 90-day death or major disability versus initial IVH (adjusted ORs 2.84 (95% CI 1.52 to 5.28) and 1.87 (1.36 to 2.56), respectively (p trend <0.0001)). Conclusions Although linked to factors determining greater ICH growth including poor SBP control, dIVH is independently associated with poor outcome in acute small to moderate-size ICH. Trial registration numbers NCT00226096 and NCT00716079.

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