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Cerebrovascular disease
Research paper
Prognostic significance of delayed intraventricular haemorrhage in the INTERACT studies
  1. Tom J Moullaali1,
  2. Shoichiro Sato1,
  3. Xia Wang1,2,
  4. Alejandro A Rabinstein3,
  5. Hisatomi Arima1,2,4,
  6. Cheryl Carcel1,
  7. Guofang Chen5,
  8. Thompson Robinson6,
  9. Emma Heeley1,2,
  10. Edward Chan1,2,
  11. Candice Delcourt1,2,7,
  12. Christian Stapf8,9,
  13. Charlotte Cordonnier10,
  14. Richard I Lindley1,2,11,
  15. John Chalmers1,2,
  16. Craig S Anderson1,2,7
  17. for the INTERACT Investigators
  1. 1The George Institute for Global Health, Sydney, Australia
  2. 2Sydney Medical School, The University of Sydney, Sydney, Australia
  3. 3Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
  4. 4Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan
  5. 5Department of Neurology, Xuzhou Central Hospital, Jiangsu, China
  6. 6Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, UK
  7. 7Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
  8. 8Department of Neurology, CRCHUM, APHP—Hôpital Lariboisière, Paris, France
  9. 9Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada
  10. 10University of Lille, CHRU, INSERM U 1171, Lille, France
  11. 11Westmead Hospital Clinical School, Sydney, Australia
  1. Correspondence to Professor Craig S Anderson, The George Institute for Global Health, Royal Prince Alfred Hospital and The University of Sydney, Sydney, NSW 2050, Australia; canderson{at}georgeinstitute.org.au

Abstract

Background and purpose Intraventricular extension of intracerebral haemorrhage (ICH) predicts poor outcome, but the significance of delayed intraventricular haemorrhage (dIVH) is less well defined. We determined the prognostic significance of dIVH in the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trials (INTERACT 1 and 2).

Methods Pooled analyses of the INTERACT CT substudies—international, multicentre, prospective, open, blinded end point, randomised controlled trials of patients with acute spontaneous ICH and elevated systolic blood pressure (SBP)—randomly assigned to intensive (<140 mm Hg) or guideline-based (<180 mm Hg) SBP management. Participants had blinded central analyses of baseline and 24 h CTs, with dIVH defined as new intraventricular haemorrhage (IVH) on the latter scan. Outcomes of death and major disability were defined by modified Rankin Scale scores at 90 days.

Results There were 349 (27%) of 1310 patients with baseline IVH, and 107 (11%) of 961 initially IVH-free patients who developed dIVH. Significant associations of dIVH were prior warfarin anticoagulation, high (≥15) baseline National Institutes of Health Stroke Scale score, larger (≥15 mL) ICH volume, greater ICH growth and higher achieved SBP over 24 h. Compared with those who were IVH-free, dIVH had greater odds of 90-day death or major disability versus initial IVH (adjusted ORs 2.84 (95% CI 1.52 to 5.28) and 1.87 (1.36 to 2.56), respectively (p trend <0.0001)).

Conclusions Although linked to factors determining greater ICH growth including poor SBP control, dIVH is independently associated with poor outcome in acute small to moderate-size ICH.

Trial registration numbers NCT00226096 and NCT00716079.

https://doi.org/10.1136/jnnp-2015-311562

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    Footnotes

    • Collaborators INTERACT Investigators (see online only reference ‘Supplementary file).

    • Contributors TJM, SS, AAR and CSA contributed to the study rationale and interpretation of the results. TJM was responsible for the first draft of the manuscript. XW and HA contributed to the data analysis. All the authors participated in the drafting of the manuscript and gave approval of its final version; and they also take responsibility for the content and interpretation of this manuscript.

    • Funding This work was supported by programme (358395 and 571281) and project (512402 and 1004170) grants from the National Health and Medical Research Council (NHMRC) of Australia.

    • Disclaimer The study was designed, conducted, analysed and interpreted by the investigators independent of sponsors.

    • Competing interests SS holds a fellowship from the Uehara Memorial Foundation of Japan. TR reports consultancy payments from Boehringer Ingelheim and Daiichi Sankyo, and his institution has received grant funding from the National Institute of Health Research, British Heart Foundation, Stroke Association, and the Engineering and Physical Sciences Research Council. CCo reports advisory board fees for Bayer (no personal fees, honoraria paid to ADRINORD). JC reports grants from the NHMRC during the conduct of the study; grants from Servier International outside the submitted work and being a chief or co-chief investigator for other large stroke trials. CSA reports grant support from the NHMRC; advisory board fees from Pfizer and The Medicines Company, and speaker fees from Takeda China and Covidien.

    • Patient consent Obtained.

    • Ethics approval The INTERACT 1 and 2 studies received ethics committee approvals at all participating hospitals.

    • Provenance and peer review Not commissioned; externally peer reviewed.