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Racial/ethnic differences in the risk of intracranial hemorrhage among patients with atrial fibrillation.
J Am Coll Cardiol. 2007 Jul 24; 50(4):309-15.JACC

Abstract

OBJECTIVES

This study was designed to study racial/ethnic differences in the risk for intracranial hemorrhage (ICH) and the effect of warfarin on ICH risk among patients with atrial fibrillation (AF).

BACKGROUND

Nonwhites are at greater risk for ICH than whites in the general population. Whether this applies to patients with AF and whether warfarin therapy is associated with comparable risk of ICH in nonwhites are unknown.

METHODS

We retrospectively identified a multiethnic stroke-free cohort hospitalized with nonrheumatic AF. Warfarin use and anticoagulation intensity were assessed by searching pharmacy and laboratory records. Crude ICH event rates were calculated by Poisson regression. Cox proportional hazard models were constructed to assess the independent effect of race/ethnicity on ICH after adjusting for age, gender, hypertension, diabetes, heart failure, and warfarin exposure.

RESULTS

Between 1995 and 2000, we identified 18,867 qualifying AF hospitalizations (78.5% white, 8% black, 9.5% Hispanic, and 3.9% Asian) and 173 qualifying ICH events over 3.3 years follow-up. Achieved anticoagulation intensity was lower among blacks but not different between the other groups. Warfarin was associated with increased ICH risk in all races, but the magnitude of risk was greater among nonwhites. There were no gender differences. The hazard ratio for ICH with whites as referent was 4.06 for Asians (95% confidence interval [CI] 2.47 to 6.65), 2.06 for Hispanics (95% CI 1.31 to 3.24), and 2.04 (95% CI 1.25 to 3.35) for blacks.

CONCLUSIONS

Nonwhites with AF were at greater risk for warfarin-related ICH. Blacks, Hispanics, and Asians were at successively greater ICH risk than whites.

Authors+Show Affiliations

Department of Cardiology and the Center for Medical Education, Kaiser Permanente Medical Center, Los Angeles, California 90027, USA. albert.y-j.shen@kp.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17659197

Citation

Shen, Albert Yuh-Jer, et al. "Racial/ethnic Differences in the Risk of Intracranial Hemorrhage Among Patients With Atrial Fibrillation." Journal of the American College of Cardiology, vol. 50, no. 4, 2007, pp. 309-15.
Shen AY, Yao JF, Brar SS, et al. Racial/ethnic differences in the risk of intracranial hemorrhage among patients with atrial fibrillation. J Am Coll Cardiol. 2007;50(4):309-15.
Shen, A. Y., Yao, J. F., Brar, S. S., Jorgensen, M. B., & Chen, W. (2007). Racial/ethnic differences in the risk of intracranial hemorrhage among patients with atrial fibrillation. Journal of the American College of Cardiology, 50(4), 309-15.
Shen AY, et al. Racial/ethnic Differences in the Risk of Intracranial Hemorrhage Among Patients With Atrial Fibrillation. J Am Coll Cardiol. 2007 Jul 24;50(4):309-15. PubMed PMID: 17659197.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial/ethnic differences in the risk of intracranial hemorrhage among patients with atrial fibrillation. AU - Shen,Albert Yuh-Jer, AU - Yao,Janis F, AU - Brar,Somjot S, AU - Jorgensen,Michael B, AU - Chen,Wansu, Y1 - 2007/07/06/ PY - 2006/11/07/received PY - 2007/01/08/revised PY - 2007/01/17/accepted PY - 2007/7/31/pubmed PY - 2007/8/22/medline PY - 2007/7/31/entrez SP - 309 EP - 15 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 50 IS - 4 N2 - OBJECTIVES: This study was designed to study racial/ethnic differences in the risk for intracranial hemorrhage (ICH) and the effect of warfarin on ICH risk among patients with atrial fibrillation (AF). BACKGROUND: Nonwhites are at greater risk for ICH than whites in the general population. Whether this applies to patients with AF and whether warfarin therapy is associated with comparable risk of ICH in nonwhites are unknown. METHODS: We retrospectively identified a multiethnic stroke-free cohort hospitalized with nonrheumatic AF. Warfarin use and anticoagulation intensity were assessed by searching pharmacy and laboratory records. Crude ICH event rates were calculated by Poisson regression. Cox proportional hazard models were constructed to assess the independent effect of race/ethnicity on ICH after adjusting for age, gender, hypertension, diabetes, heart failure, and warfarin exposure. RESULTS: Between 1995 and 2000, we identified 18,867 qualifying AF hospitalizations (78.5% white, 8% black, 9.5% Hispanic, and 3.9% Asian) and 173 qualifying ICH events over 3.3 years follow-up. Achieved anticoagulation intensity was lower among blacks but not different between the other groups. Warfarin was associated with increased ICH risk in all races, but the magnitude of risk was greater among nonwhites. There were no gender differences. The hazard ratio for ICH with whites as referent was 4.06 for Asians (95% confidence interval [CI] 2.47 to 6.65), 2.06 for Hispanics (95% CI 1.31 to 3.24), and 2.04 (95% CI 1.25 to 3.35) for blacks. CONCLUSIONS: Nonwhites with AF were at greater risk for warfarin-related ICH. Blacks, Hispanics, and Asians were at successively greater ICH risk than whites. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/17659197/Racial/ethnic_differences_in_the_risk_of_intracranial_hemorrhage_among_patients_with_atrial_fibrillation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)01470-2 DB - PRIME DP - Unbound Medicine ER -