Migraine linked to stroke risk after surgery
medwireNews: Surgical patients with a history of migraine are at increased risk for perioperative ischemic stroke and hospital readmission within 30 days, study findings indicate.
The results predict an absolute risk of 4.3 ischemic strokes for every 1000 surgical patients with a history of any migraine diagnosis, compared with 2.4 for every 1000 surgical patients without migraine.
The risk was greatest for patients with migraine with aura, at 6.3 strokes for every 1000 surgical patients, compared with 3.9 for those with migraine without aura.
“Given the high prevalence of migraine in the general population, the migraine-perioperative ischemic stroke association carries public health importance, and physicians should be aware of this increased perioperative risk, particularly in patients with migraine who present with traditional risk factors for stroke,” say Matthias Eikermann (Massachusetts General Hospital and Harvard Medical School, Boston, USA) and fellow researchers.
“We believe that an individual perioperative risk assessment for perioperative ischemic stroke in patients with migraine undergoing surgery may be crucial.”
Patients with migraine, with or without aura, were also significantly more likely than those without to be readmitted to hospital within 30 days of being discharged, at an adjusted odds ratio of 1.31.
A total of 124,558 surgical patients (54.5% women) aged a mean of 52.6 years participated in the study. Of these, 10,179 (8.2%) had migraine – 12.6% with aura and 87.4% without.
Perioperative ischemic stroke occurred in 771 patients, of whom 89 had migraine. This meant migraine patients had a 75% greater risk for stroke than those without after adjustment for disease- and surgery-related factors, including pre-existing vascular disease.
Subgroup analyses also showed this heightened risk for perioperative stroke existed in migraine patients who were otherwise at relatively low risk for stroke and in patients undergoing ambulatory surgery, rates of which are increasing and exceeding those of inpatient surgery, the researchers note.
Eikermann and team speculate in The BMJ that a genetic predisposition and an increased vulnerability to cerebral ischemia are likely to underlie the exacerbated perioperative stroke risk. And on the basis of exploratory data analysis, they suggest that the use of high doses of vasopressors during surgery and a pre-existing right-to-left cardiac shunt represent risk factors to avoid.
By Lucy Piper
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