Risks of recurrent stroke and all serious vascular events after spontaneous intracerebral haemorrhage: pooled analyses of two population-based studies

Background Patients with stroke due to spontaneous (non-traumatic) intracerebral haemorrhage (ICH) are at risk of recurrent ICH, ischaemic stroke, and other serious vascular events. We aimed to analyse these risks in population-based studies and compare them with the risks in RESTART, which assessed antiplatelet therapy after ICH. Methods We pooled individual patient data from two prospective, population-based inception cohort studies of all patients with an incident firs-in-a-lifetime ICH in Oxfordshire, England (Oxford Vascular Study; April 1, 2002, to Sept 28, 2018) and Lothian, Scotland, UK (Lothian Audit of the Treatment of Cerebral Haemorrhage; June 1, 2010, to May 31, 2013). We quantified the absolute and relative risks of recurrent ICH, ischaemic stroke, or any serious vascular event (non-fatal stroke, non-fatal myocardial infarction, or vascular death), stratified by ICH location (lobar vs non-lobar) and comorbid atrial fibrillation (AF). We compared pooled event rates with those after allocation to avoid antiplatelet therapy in RESTART. Findings Among 674 patients (mean age 74·7 years [SD 12·6], 320 [47%] men) with 1553 person-years of follow-up, 46 recurrent ICHs (event rate 3·2 per 100 patient-years, 95% CI 2·0–5·1) and 25 ischaemic strokes (1·7 per 100 patient-years, 0·8–3·3) were reported. Patients with lobar ICH (n=317) had higher risk of recurrent ICH (5·1 per 100 patient-years, 95% CI 3·6–7·2) than patients with non-lobar ICH (n=355; 1·8 per 100 patient-years, 1·0–3·3; hazard ratio [HR] 3·2, 95% CI 1·6–6·3; p=0·0010), but there was no evidence of a difference in the risk of ischaemic stroke (1·8 per 100 patient-years, 1·0–3·2, vs 1·6 per 100 patient-years, 0·6–4·4; HR 1·1, 95% CI 0·5–2·8). Conversely, there was no evidence of a difference in recurrent ICH rate in patients with AF (n=147; 3·3 per 100 patient-years, 95% CI 1·0–10·7) compared with those without (n=526; 3·2 per 100 patient-years, 2·2–4·7; HR 0·9, 95% CI 0·4–2·1), but the risk of ischaemic stroke was higher with AF (6·3 per 100 patient-years, 3·7–10·9, vs 0·7 per 100 patient-years, 0·1–5·6; HR 8·2, 3·3–20·3; p<0·0001), resulting in patients with AF having a higher risk of all serious vascular events than patients without AF (15·5 per 100 patient-years, 10·0–24·1, vs 6·8 per 100 patient-years, 3·6–12·5; HR 1·78, 95% CI 1·16–2·74; p=0·0090). Only for patients with lobar ICH without comorbid AF was the risk of recurrent ICH greater than the risk of ischaemic stroke (5·2 per 100 patient-years, 95% CI 3·6–7·5, vs 0·9 per 100 patient-years, 0·2–4·8; p=0·00034). Comparing data from the pooled population-based studies with that from patients allocated to not receive antiplatelet therapy in RESTART, there was no evidence of a difference in the rate of recurrent ICH (3·5 per 100 patient-years, 95% CI 1·9–6·0, vs 4·4 per 100 patient-years, 2·6–6·1) or ischaemic stroke (3·4 per 100 patient-years, 1·9–5·9, vs 5·3 per 100 patient-years, 3·3–7·2). Interpretation The risks of recurrent ICH, ischaemic stroke, and all serious vascular events after ICH differ by ICH location and comorbid AF. These data enable risk stratification of patients in clinical practice and ongoing randomised trials

Perfil social das gestantes em unidades de saúde da família do município de Teresópolis Pregnants' social profile in family health unities from the county of Teresópolis, Rio de Janeiro

Estudo descritivo de mulheres gestantes, com o objetivo de caracterizar as mulheres em relação às condições sociais e à assistência à gestação. As observações pertencem a um estudo transversal, a partir de uma amostra de 69 gestantes, inscritas nas unidades de saúde da família de Beira Linha, Araras e Rosário, residentes em Teresópolis (RJ). A análise comparativa entre gestantes adolescentes x não adolescentes considerou o teste exato de Fisher para mensurar possíveis significâncias estatísticas. No período considerado, 31,9% eram mães adolescentes. Entre essas, 72,7% estavam em sua primeira gestação, e 31,9% das não adolescentes encontravam-se nessa situação (p-valor < 0,01). O papel da família na orientação quanto ao sexo é mais marcante entre as gestantes adolescentes (59,1%) do que entre as não adolescentes (25,5%) (p-valor <0,01). Cerca de 70% das mulheres engravidaram do primeiro parceiro sexual, apesar de não ter planejado a gravidez, e de 25% estar utilizando algum método contraceptivo. Embora a mãe das gestantes adolescentes possuam, em média, um número superior de filhos, quando comparadas às mães das gestantes não adolescentes, essa tendência não se repetiu entre suas filhas, o que pode estar relacionado a melhores condições sociais observadas na população estudada.<br>Descriptive study of pregnants, aiming the characterization of women in relation to social condition and pregnancy assistance. The observations are part of a transversal study, considering a sample of 69 pregnants, registered in the Family Health Unities of Beira Linha, Araras and Rosário, residing in the county of Teresópolis, Rio de Janeiro, Brazil. The comparative analysis among adolescent and non-adolescent pregnants considered the exact test of Fisher to measure statistical significance. In the considered period, 31,9% were found adolescent mothers. Among then, 72,7% were in their first gestation, and 31,9 % from the non-adolescent mothers were found in this situation (p-value< 0,01). The family role in the sexual orientation is stronger among adolescent pregnants (59,1%) than among the non-adolescent ones (25,5%) (p-value < 0,01). Near 70% of the women got pregnant from their first sexual partner, although pregnancy have not been planned before, and 25% of them were making use of a king of contraceptive method. Although the adolescent pregnants' mothers have an average of a superior number of children, when compared to the non-adolescent pregnants' mothers, this tendency was not followed by their daugthers, and this maybe related to better social conditions, observed in the researched population