Systemic Amyloidosis in Older Adults Linked to Increased Intracranial Haemorrhage Risk

February 14, 2022

By Nancy Melville

 VIRTUAL -- February 14, 2022 -- Systemic amyloidosis in older patients is associated with a significant increase in the risk of intracranial haemorrhage, according to a study presented at the 2022 International Stroke Conference (ISC).

“In a large, heterogeneous national cohort of elderly patients, a diagnosis of systemic amyloidosis was associated with a 4-fold increased risk of intracranial haemorrhage, including intracerebral, subarachnoid, and subdural haemorrhages,” reported Dora Chen, MD, Weill Cornell Medicine, New York, New York. 

For the study, the researchers evaluated claims data on 1.8 million Medicare beneficiaries between 2008 and 2015, identifying 924 patients who were diagnosed with systemic amyloidosis. 

Over a median follow-up of 5.3 years, the cumulative rate of intracranial haemorrhage was 19 per 1,000 patients per year among patients who had systemic amyloidosis, compared with 2 per 1,000 patients per year among those without systemic amyloidosis. 

After adjustment for demographic factors, as well as vascular risk factors and comorbidities, having systemic amyloidosis significantly increased the risk of intracranial haemorrhage (hazard ratio [HR] = 4.3; 95% confidence interval [CI], 2.9-6.3). In a further sensitivity analysis in which patients with cardiac amyloidosis were excluded, the increased risk was even higher (HR = 8.0; 95% CI, 5.0-12.7). 

A secondary analyses evaluating the risk associated with intracranial haemorrhage subtypes showed systemic amyloidosis to significantly increase the risk of intracerebral haemorrhage (HR = 5.6; 95% CI, 3.6-8.7), subarachnoid haemorrhage (HR = 14.7; 95% 9.0-24.0), and subdural haemorrhage (HR = 3.6; 95% 2.0-6.2). 

For a comparison control, the authors further evaluated the association between systemic amyloidosis with hip fracture, another common incident condition among the elderly, and found no link between the two (HR = 0.9; 95% CI, 0.6-1.4). 

“While further research is warranted, clinicians should be aware of this heightened intracranial bleeding risk, especially in the context of prescribing antithrombotic drugs,” said Dr. Chen. 

ISC is sponsored by the American Heart Association and the American Stroke Association.

[Presentation title: Association Between Systemic Amyloidosis and Intracranial Hemorrhage. Abstract WMP81]