Affiliation:
1. Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
2. Department of Pharmacology, Kyoto University Graduate School of Medicine, Kyoto, Japan
3. Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
4. Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
Abstract
Background: Hemorrhagic stroke (HS) is a sudden-onset disease with high mortality and disability rates, and it is crucial to explore the triggers of HS. In this study, we analyzed individual triggers for HS to provide a basis for HS prevention and intervention. Methods: A systematic search of five databases was conducted until December 2022. Studies on HS-related individual triggers conducted using a case-crossover study or self-controlled case series design were included in the descriptive summary and comprehensive evidence synthesis of each trigger. Results: A total of 39 studies were included after the screening, and 32 trigger factor categories were explored for associations. Potential trigger factors for HS were as follows: Antiplatelet (odd ratio (OR), 1.10; 95% confidence interval (CI), 1.00–1.21) and anticoagulant (OR, 5.43; 95% CI, 2.04–14.46) medications, mood stabilizers/antipsychotics (OR, 1.33; 95% CI, 1.07–1.65), infections (OR, 2.15; 95% CI, 1.73–2.67), vaccinations (relative risk, 1.11; 95% CI, 1.02–1.21), physical exertion (OR, 2.08; 95% CI, 1.58–2.74), cola consumption (OR, 5.45; 95% CI, 2.76–10.76), sexual activity (OR, 7.49; 95% CI, 2.23–25.22), nose blowing (OR range, 2.40–56.40), defecation (OR, 16.94; 95% CI, 3.40–84.37), and anger (OR, 3.59; 95% CI, 1.56–8.26). No associations were observed with illicit drug use (OR, 2.05; 95% CI, 0.52–8.06) or cigarette smoking (OR, 0.81; 95% CI, 0.52–1.24) and HS. Conclusions: Individual triggers, including several medications, infections, vaccinations, and behaviors, may trigger HS onset. Direct control measures for behavioral triggers can play a crucial role in preventing HS. High-risk populations should receive personalized therapies and monitoring measures during the medication treatment to balance the risk of acute HS and the basic diseases.
Funder
Hunan Province Nature Science Foundation, China
Central South University Case Database Construction Project for Graduate Students, China
Subject
Cardiology and Cardiovascular Medicine,Neurology (clinical)
Cited by
3 articles.
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