Does Cirrhosis Increase the Risk for Stroke?

Patients with cirrhosis have an increased risk for stroke, according to a recent study.

The retrospective cohort study included 1,618,059 Medicare beneficiaries older than 66 years of age. Incidence of stroke was assessed as the primary outcome, and incidence of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage were assessed as the secondary outcomes.  
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Of the beneficiaries included in the study, 15,586 (1%) had cirrhosis (mean age 74.1 years, 7263 [46.6%] were female). A total of 77,268 patients were hospitalized with stroke over the mean 4.3 years of follow-up.

In patients with cirrhosis, the incidence of stroke was 2.17% per year compared with 1.11% per year in patients without cirrhosis. Patients with cirrhosis had a higher risk for stroke after researchers adjusted for demographic characteristics and stroke risk factors (hazard ratio [HR] 1.4).

This association appeared to be stronger for intracerebral hemorrhage and subarachnoid hemorrhage compared with ischemic stroke (HR 2.4 and HR 1.9 vs HR 1.3, respectively). 

“In a nationally representative sample of Medicare beneficiaries, cirrhosis was associated with an increased risk of stroke, particularly hemorrhagic stroke,” the researchers concluded. “A potential explanation of these findings implicates the mixed coagulopathy observed in cirrhosis.”

—Melissa Weiss

Reference:

Parikh NS, Navi BB, Schneider Y, et al. Association between cirrhosis and stroke in a nationally representative cohort [published online June 5, 2017]. JAMA Neurol. doi:10.1001/jamaneurol.2017.0923.