Abstract 2733: The Comparative Importance of `Shared' Risk Factors for Ischemic Stroke and Intracerebral Hemorrhage in Patients with Atrial Fibrillation
Bibliographic record
Abstract
Background: Optimal prescribing of oral anticoagulants, for the prevention of stroke in patients with atrial fibrillation, requires clinicians to estimate the competing risk of ischemic stroke and intracerebral hemorrhage (ICH). However, a number of risk factors increase the risk of both ischemic stroke and ICH (e.g. age, hypertension and chronic renal disease), and it is unclear how these ‘shared’ risk factors should influence decisions on antithrombotic therapy. Objective: To determine the comparative importance of risk factors for ischemic stroke and ICH in patients with atrial fibrillation, focusing primarily on risk factors included in the CHA2DS2VASC (risk of ischemic stroke) and HAS-BLED (risk of major bleeding) scores. Methods: Prospective registry of 3,197 patients admitted with acute ischemic stroke or ICH and atrial fibrillation included in the Registry of the Canadian Stroke Network (Jul 03-Mar 08; 11 Regional Stroke Centers in Ontario, Canada). Multivariable analysis was used to determine the association between baseline risk factors (age, sex, history of hypertension, previous stroke or transient ischemic attack, history of congestive heart failure, history of vascular disease, hepatic impairment, current alcohol intake, history of diabetes mellitus, history of gastro-intestinal bleeding, renal impairment, admission INR and antiplatelet therapy) and risk of ischemic stroke versus ICH. Results: Of 3,197 patients with atrial fibrillation and acute stroke, 2,806 (87.8%) presented with an ischemic stroke and 391 (12.2%) presented with an ICH. Of the ‘shared’ risk factors, age (OR 1.17; 95% CI 1.04-1.31 per decade) and previous history of stroke (OR 1.40; 95% CI 1.09-1.81) were associated with an increased risk of ischemic stroke relative to ICH, while a history of hypertension (OR 0.90; 95% CI 0.69-1.18) and renal impairment (OR 1.29; 0.96-1.72) were not associated with either stroke subtype, on multivariable analyses. Of the ‘non-shared’ risk factors, alcohol consumption of <2 units/day vs. no consumption (OR 1.61; 95% CI 1.24-2.09), female sex (OR 1.53; 95% CI 1.20-1.96) and a history of vascular disease (OR 1.73; 95% CI 1.30- 2.30) were associated with an increased risk of ischemic stroke relative to ICH. Elevated INR at the time of admission was a significant predictor of ICH, relative to ischemic stroke. Conclusion: None of the ‘shared’ risk factors were stronger predictors of ICH compared to ischemic stroke, which has obvious implications for clinical practice. In particular, older age was more strongly associated with ischemic stroke than ICH in patients with atrial fibrillation, and therefore, should be considered as a factor favoring a decision to commence anticoagulant therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".