Juha Huhtakangas - Academia.edu (original) (raw)

Papers by Juha Huhtakangas

Research paper thumbnail of Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage

Annals of Neurology, 2015

Objective: There is little evidence to guide treatment strategies for intracerebral hemorrhage on... more Objective: There is little evidence to guide treatment strategies for intracerebral hemorrhage on vitamin K antagonists (VKA-ICH). Treatments utilized in clinical practice include fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC). Our aim was to compare case fatality with different reversal strategies. Methods: We pooled individual ICH patient data from 16 stroke registries in 9 countries (n 5 10 282), of whom 1,797 (17%) were on VKA. After excluding 250 patients with international normalized ratio < 1.3 and/or missing data required for analysis, we compared all-cause 30-day case fatality using Cox regression. Results: We included 1,547 patients treated with FFP (n 5 377, 24%), PCC (n 5 585, 38%), both (n 5 131, 9%), or neither (n 5 454, 29%). The crude case fatality and adjusted hazard ratio (HR) were highest with no reversal (61.7%, View this article online at wileyonlinelibrary.com.

Research paper thumbnail of Predictive value of C-reactive protein for the outcome after primary intracerebral hemorrhage

Journal of neurosurgery, 2014

Primary intracerebral hemorrhage (ICH) carries high morbidity and mortality rates. Several factor... more Primary intracerebral hemorrhage (ICH) carries high morbidity and mortality rates. Several factors have been suggested as predicting the outcome. The value of C-reactive protein (CRP) levels in predicting a poor outcome is unclear, and findings have been contradictory. In their population-based cohort, the authors tested whether, independent of confounding factors, elevated CRP levels on admission (< 24 hours after ictus) are associated with an unfavorable outcome. The authors identified all patients who suffered primary ICH between 1993 and 2008 among the population of Northern Ostrobothnia, Finland, and from the laboratory records they extracted the CRP values at admission. Independent predictors of an unfavorable outcome (moderate disability or worse according to the Glasgow Outcome Scale at 3 months) were tested by unconditional logistic regression in a model including all the well-established confounding factors and CRP on admission. Of 961 patients, 807 (84%) had CRP values...

Research paper thumbnail of Predictors for Recurrent Primary Intracerebral Hemorrhage: A Retrospective Population-based Study

Research paper thumbnail of Effect of Increased Warfarin Use on Warfarin-Related Cerebral Hemorrhage: A Longitudinal Population-Based Study

Stroke, 2011

Background and Purpose-Warfarin use has rapidly increased with the aging of the population. We in... more Background and Purpose-Warfarin use has rapidly increased with the aging of the population. We investigated the temporal trends in the incidence and outcome of warfarin-related intracerebral hemorrhages (ICHs) in a defined population. Methods-We identified all subjects with first-ever primary ICH during 1993 to 2008 among the population of Northern Ostrobothnia, Finland. The number of warfarin users was obtained from the national register of prescribed medicines kept by the Social Insurance Institution of Finland. We calculated the annual incidence of warfarin-related ICHs, 28-day case fatality, and deaths from the primary bleed. Results-The proportion of warfarin users among the population increased 3.6-fold from 0.68% in 1993 to 2.28% in 2008.

Research paper thumbnail of Association between warfarin combined with serotonin-modulating antidepressants and increased case fatality in primary intracerebral hemorrhage: a population-based study

Journal of Neurosurgery, 2014

Patients receiving oral anticoagulants run a higher risk of cerebral hemorrhage with a poor outco... more Patients receiving oral anticoagulants run a higher risk of cerebral hemorrhage with a poor outcome. Serotonin-modulating antidepressants (selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors [SNRIs]) are frequently used in combination with warfarin, but it is unclear whether this combination of drugs influences outcome after primary intracerebral hemorrhage (PICH). The authors investigated case fatality in PICH among patients from a defined population who were receiving warfarin alone, with aspirin, or with serotonin-modulating antidepressants. Nine hundred eighty-two subjects with PICH were derived from the population of Northern Ostrobothnia, Finland, for the years 1993-2008, and those with warfarin-associated PICH were eligible for analysis. Their hospital records were reviewed, and medication data were obtained from the national register of prescribed medicines. Kaplan-Meier survival curves were drawn to illustrate cumulative case fatality, and a Cox proportional-hazards analysis was performed to demonstrate predictors of death. Of the 176 patients eligible for analysis, 17 had been taking aspirin and 19 had been taking SSRI/SNRI together with warfarin. The 30-day case fatality rates were 50.7%, 58.8%, and 78.9%, respectively, for those taking warfarin alone, with aspirin, or with SSRI/SNRI (p = 0.033, warfarin plus SSRI/SNRI compared with warfarin alone). Warfarin combined with SSRI/SNRI was a significant independent predictor of case fatality (adjusted HR 2.10, 95% CI 1.13-3.92, p = 0.019). Concurrent use of warfarin and a serotonin-modulating antidepressant, relative to warfarin alone, seemed to increase the case fatality rate for PICH. This finding should be taken into account if hematoma evacuation is planned.

Research paper thumbnail of Improved survival of patients with warfarin-associated intracerebral haemorrhage: a retrospective longitudinal population-based study

International Journal of Stroke, 2012

Background Warfarin-associated intracerebral haemorrhage carries poor outcome due to rapid haemor... more Background Warfarin-associated intracerebral haemorrhage carries poor outcome due to rapid haemorrhage growth. Reversal of warfarin anticoagulation with prothrombin complex concentrate has been implemented as an acute treatment option for these subjects. Aim We investigated whether survival of subjects with warfarin-associated intracerebral haemorrhage had improved after implementation of reversal of warfarin anticoagulation with prothrombin complex concentrate. Methods We identified all subjects with warfarin-associated intracerebral haemorrhage during 1993-2008 among the population of Northern Ostrobothnia, Finland. From 2004 onwards, prothrombin complex concentrate was used in Oulu University Hospital, the only hospital treating intracerebral haemorrhage subjects in the region, to counteract the effect of warfarin in subjects with warfarin-associated intracerebral haemorrhage. We compared the outcomes of subjects admitted during 1993-2003 and 2004-2008 and those treated and not treated with prothrombin complex concentrate. We also explored the predictors for one-year survival of the warfarinassociated intracerebral haemorrhage subjects. Results We identified altogether 181 subjects who had intracerebral haemorrhage while on warfarin. One-year survival was significantly (P = 0·031) higher for the 60 subjects admitted during 2004-2008 (43·3%) than for the 121 admitted before 2004 (30·6%). In multivariable analysis, prothrombin complex concentrate treatment reduced one-year case fatality (hazard ratio 0·52, 95% confidence interval 0·29-0·93). Thromboembolic complications did not occur more frequently among those treated with prothrombin complex concentrate. Conclusion The survival of warfarin-associated intracerebral haemorrhage subjects among the population of Northern Ostrobothnia has improved likely because of introduction of prothrombin complex concentrate. *P = 0·003 for heterogeneity according to treatment with PCC. ICH, intracerebral haemorrhage; PCC, prothrombin complex concentrate.

Research paper thumbnail of Better than expected survival after primary intracerebral hemorrhage in patients with untreated hypertension despite high admission blood pressures

European Journal of Neurology, 2010

Hypertension is the most important modifiable risk factor for primary intracerebral hemorrhage (I... more Hypertension is the most important modifiable risk factor for primary intracerebral hemorrhage (ICH), but little is known of the effect of preceding hypertension on outcome. Because high mean arterial blood pressure (MABP) at admission is an independent predictor of early death in patients with ICH, we explored its role on survival and poor outcome separately in normotensive subjects and subjects with treated and untreated hypertension. We assessed clinical data and the 3-month outcome of patients with spontaneous ICH (n = 453) admitted to the stroke unit of Oulu University Hospital between 1993 and 2004. Standard medical treatment was used to lower MABP from levels &gt;127 mmHg to &lt;120 mmHg. Overall mortality within 3 months was 28%. Patients with untreated hypertension had significantly lower mortality (6%) than those with treated hypertension (36%, P &lt; 0.001) or those without hypertension (25%, P &lt; 0.01). High admission MABP associated with early death in normotensive subjects (P &lt; 0.05) and those on medication for hypertension (P &lt; 0.01) but not in those with untreated hypertension. Patients with untreated hypertension were younger and had less frequently cardiac disease, diabetes, and/or warfarin or aspirin medications, but they showed the highest blood pressures (BPs) at admission. Amongst patients with high admission MABP, favorable outcome was seen most frequently in those who had untreated hypertension. Hematoma growth did not associate with high MABP amongst them. Despite their higher BP values at admission, subjects with untreated hypertension showed better survival and more frequently favorable outcome after BP-lowering therapy than other patients.

Research paper thumbnail of Immediate, early and late seizures after primary intracerebral hemorrhage

Epilepsy Research, 2014

Background: Seizures after primary intracerebral hemorrhage (PICH) are significant and treatable ... more Background: Seizures after primary intracerebral hemorrhage (PICH) are significant and treatable complications, but the factors predicting immediate, early and late seizures are poorly known. We investigated characteristics and outcome with special reference to occurrence and timing of a first seizure among consecutive subjects with PICH. Methods: A population-based study was conducted in Northern Ostrobothnia, Finland, in 1993-2008 that included all patients with a first-ever primary ICH without any prior diagnosis of epilepsy. Immediate (<24 h after admission), early (1-14 days) and late (>2 weeks) seizures were considered separately. Results: Out of a total of 935 ICH patients, 51 had immediate, 21 early and 58 late seizures. The patients with seizures were significantly younger than the others and more often had a subcortical hematoma location (p < 0.05). Lifestyle factors did not differ between the groups. The risk factors for immediate seizures in multivariable analysis were a low Glasgow coma scale score (GCS) on admission, subcortical location and age inversely (p < 0.01). The only independent risk factor for early seizures

Research paper thumbnail of A population based study of outcomes after evacuation of primary supratentorial intracerebral hemorrhage

Clinical Neurology and Neurosurgery, 2013

Please cite this article in press as: Löppönen P, et al. A population based study of outcomes aft... more Please cite this article in press as: Löppönen P, et al. A population based study of outcomes after evacuation of primary supratentorial intracerebral hemorrhage. Clin Neurol Neurosurg (2013), http://dx.

Research paper thumbnail of Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage

Annals of Neurology, 2015

Objective: There is little evidence to guide treatment strategies for intracerebral hemorrhage on... more Objective: There is little evidence to guide treatment strategies for intracerebral hemorrhage on vitamin K antagonists (VKA-ICH). Treatments utilized in clinical practice include fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC). Our aim was to compare case fatality with different reversal strategies. Methods: We pooled individual ICH patient data from 16 stroke registries in 9 countries (n 5 10 282), of whom 1,797 (17%) were on VKA. After excluding 250 patients with international normalized ratio < 1.3 and/or missing data required for analysis, we compared all-cause 30-day case fatality using Cox regression. Results: We included 1,547 patients treated with FFP (n 5 377, 24%), PCC (n 5 585, 38%), both (n 5 131, 9%), or neither (n 5 454, 29%). The crude case fatality and adjusted hazard ratio (HR) were highest with no reversal (61.7%, View this article online at wileyonlinelibrary.com.

Research paper thumbnail of Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage

Annals of Neurology, 2015

Objective: There is little evidence to guide treatment strategies for intracerebral hemorrhage on... more Objective: There is little evidence to guide treatment strategies for intracerebral hemorrhage on vitamin K antagonists (VKA-ICH). Treatments utilized in clinical practice include fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC). Our aim was to compare case fatality with different reversal strategies. Methods: We pooled individual ICH patient data from 16 stroke registries in 9 countries (n 5 10 282), of whom 1,797 (17%) were on VKA. After excluding 250 patients with international normalized ratio < 1.3 and/or missing data required for analysis, we compared all-cause 30-day case fatality using Cox regression. Results: We included 1,547 patients treated with FFP (n 5 377, 24%), PCC (n 5 585, 38%), both (n 5 131, 9%), or neither (n 5 454, 29%). The crude case fatality and adjusted hazard ratio (HR) were highest with no reversal (61.7%, View this article online at wileyonlinelibrary.com.

Research paper thumbnail of Predictive value of C-reactive protein for the outcome after primary intracerebral hemorrhage

Journal of neurosurgery, 2014

Primary intracerebral hemorrhage (ICH) carries high morbidity and mortality rates. Several factor... more Primary intracerebral hemorrhage (ICH) carries high morbidity and mortality rates. Several factors have been suggested as predicting the outcome. The value of C-reactive protein (CRP) levels in predicting a poor outcome is unclear, and findings have been contradictory. In their population-based cohort, the authors tested whether, independent of confounding factors, elevated CRP levels on admission (< 24 hours after ictus) are associated with an unfavorable outcome. The authors identified all patients who suffered primary ICH between 1993 and 2008 among the population of Northern Ostrobothnia, Finland, and from the laboratory records they extracted the CRP values at admission. Independent predictors of an unfavorable outcome (moderate disability or worse according to the Glasgow Outcome Scale at 3 months) were tested by unconditional logistic regression in a model including all the well-established confounding factors and CRP on admission. Of 961 patients, 807 (84%) had CRP values...

Research paper thumbnail of Predictors for Recurrent Primary Intracerebral Hemorrhage: A Retrospective Population-based Study

Research paper thumbnail of Effect of Increased Warfarin Use on Warfarin-Related Cerebral Hemorrhage: A Longitudinal Population-Based Study

Stroke, 2011

Background and Purpose-Warfarin use has rapidly increased with the aging of the population. We in... more Background and Purpose-Warfarin use has rapidly increased with the aging of the population. We investigated the temporal trends in the incidence and outcome of warfarin-related intracerebral hemorrhages (ICHs) in a defined population. Methods-We identified all subjects with first-ever primary ICH during 1993 to 2008 among the population of Northern Ostrobothnia, Finland. The number of warfarin users was obtained from the national register of prescribed medicines kept by the Social Insurance Institution of Finland. We calculated the annual incidence of warfarin-related ICHs, 28-day case fatality, and deaths from the primary bleed. Results-The proportion of warfarin users among the population increased 3.6-fold from 0.68% in 1993 to 2.28% in 2008.

Research paper thumbnail of Association between warfarin combined with serotonin-modulating antidepressants and increased case fatality in primary intracerebral hemorrhage: a population-based study

Journal of Neurosurgery, 2014

Patients receiving oral anticoagulants run a higher risk of cerebral hemorrhage with a poor outco... more Patients receiving oral anticoagulants run a higher risk of cerebral hemorrhage with a poor outcome. Serotonin-modulating antidepressants (selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors [SNRIs]) are frequently used in combination with warfarin, but it is unclear whether this combination of drugs influences outcome after primary intracerebral hemorrhage (PICH). The authors investigated case fatality in PICH among patients from a defined population who were receiving warfarin alone, with aspirin, or with serotonin-modulating antidepressants. Nine hundred eighty-two subjects with PICH were derived from the population of Northern Ostrobothnia, Finland, for the years 1993-2008, and those with warfarin-associated PICH were eligible for analysis. Their hospital records were reviewed, and medication data were obtained from the national register of prescribed medicines. Kaplan-Meier survival curves were drawn to illustrate cumulative case fatality, and a Cox proportional-hazards analysis was performed to demonstrate predictors of death. Of the 176 patients eligible for analysis, 17 had been taking aspirin and 19 had been taking SSRI/SNRI together with warfarin. The 30-day case fatality rates were 50.7%, 58.8%, and 78.9%, respectively, for those taking warfarin alone, with aspirin, or with SSRI/SNRI (p = 0.033, warfarin plus SSRI/SNRI compared with warfarin alone). Warfarin combined with SSRI/SNRI was a significant independent predictor of case fatality (adjusted HR 2.10, 95% CI 1.13-3.92, p = 0.019). Concurrent use of warfarin and a serotonin-modulating antidepressant, relative to warfarin alone, seemed to increase the case fatality rate for PICH. This finding should be taken into account if hematoma evacuation is planned.

Research paper thumbnail of Improved survival of patients with warfarin-associated intracerebral haemorrhage: a retrospective longitudinal population-based study

International Journal of Stroke, 2012

Background Warfarin-associated intracerebral haemorrhage carries poor outcome due to rapid haemor... more Background Warfarin-associated intracerebral haemorrhage carries poor outcome due to rapid haemorrhage growth. Reversal of warfarin anticoagulation with prothrombin complex concentrate has been implemented as an acute treatment option for these subjects. Aim We investigated whether survival of subjects with warfarin-associated intracerebral haemorrhage had improved after implementation of reversal of warfarin anticoagulation with prothrombin complex concentrate. Methods We identified all subjects with warfarin-associated intracerebral haemorrhage during 1993-2008 among the population of Northern Ostrobothnia, Finland. From 2004 onwards, prothrombin complex concentrate was used in Oulu University Hospital, the only hospital treating intracerebral haemorrhage subjects in the region, to counteract the effect of warfarin in subjects with warfarin-associated intracerebral haemorrhage. We compared the outcomes of subjects admitted during 1993-2003 and 2004-2008 and those treated and not treated with prothrombin complex concentrate. We also explored the predictors for one-year survival of the warfarinassociated intracerebral haemorrhage subjects. Results We identified altogether 181 subjects who had intracerebral haemorrhage while on warfarin. One-year survival was significantly (P = 0·031) higher for the 60 subjects admitted during 2004-2008 (43·3%) than for the 121 admitted before 2004 (30·6%). In multivariable analysis, prothrombin complex concentrate treatment reduced one-year case fatality (hazard ratio 0·52, 95% confidence interval 0·29-0·93). Thromboembolic complications did not occur more frequently among those treated with prothrombin complex concentrate. Conclusion The survival of warfarin-associated intracerebral haemorrhage subjects among the population of Northern Ostrobothnia has improved likely because of introduction of prothrombin complex concentrate. *P = 0·003 for heterogeneity according to treatment with PCC. ICH, intracerebral haemorrhage; PCC, prothrombin complex concentrate.

Research paper thumbnail of Better than expected survival after primary intracerebral hemorrhage in patients with untreated hypertension despite high admission blood pressures

European Journal of Neurology, 2010

Hypertension is the most important modifiable risk factor for primary intracerebral hemorrhage (I... more Hypertension is the most important modifiable risk factor for primary intracerebral hemorrhage (ICH), but little is known of the effect of preceding hypertension on outcome. Because high mean arterial blood pressure (MABP) at admission is an independent predictor of early death in patients with ICH, we explored its role on survival and poor outcome separately in normotensive subjects and subjects with treated and untreated hypertension. We assessed clinical data and the 3-month outcome of patients with spontaneous ICH (n = 453) admitted to the stroke unit of Oulu University Hospital between 1993 and 2004. Standard medical treatment was used to lower MABP from levels &gt;127 mmHg to &lt;120 mmHg. Overall mortality within 3 months was 28%. Patients with untreated hypertension had significantly lower mortality (6%) than those with treated hypertension (36%, P &lt; 0.001) or those without hypertension (25%, P &lt; 0.01). High admission MABP associated with early death in normotensive subjects (P &lt; 0.05) and those on medication for hypertension (P &lt; 0.01) but not in those with untreated hypertension. Patients with untreated hypertension were younger and had less frequently cardiac disease, diabetes, and/or warfarin or aspirin medications, but they showed the highest blood pressures (BPs) at admission. Amongst patients with high admission MABP, favorable outcome was seen most frequently in those who had untreated hypertension. Hematoma growth did not associate with high MABP amongst them. Despite their higher BP values at admission, subjects with untreated hypertension showed better survival and more frequently favorable outcome after BP-lowering therapy than other patients.

Research paper thumbnail of Immediate, early and late seizures after primary intracerebral hemorrhage

Epilepsy Research, 2014

Background: Seizures after primary intracerebral hemorrhage (PICH) are significant and treatable ... more Background: Seizures after primary intracerebral hemorrhage (PICH) are significant and treatable complications, but the factors predicting immediate, early and late seizures are poorly known. We investigated characteristics and outcome with special reference to occurrence and timing of a first seizure among consecutive subjects with PICH. Methods: A population-based study was conducted in Northern Ostrobothnia, Finland, in 1993-2008 that included all patients with a first-ever primary ICH without any prior diagnosis of epilepsy. Immediate (<24 h after admission), early (1-14 days) and late (>2 weeks) seizures were considered separately. Results: Out of a total of 935 ICH patients, 51 had immediate, 21 early and 58 late seizures. The patients with seizures were significantly younger than the others and more often had a subcortical hematoma location (p < 0.05). Lifestyle factors did not differ between the groups. The risk factors for immediate seizures in multivariable analysis were a low Glasgow coma scale score (GCS) on admission, subcortical location and age inversely (p < 0.01). The only independent risk factor for early seizures

Research paper thumbnail of A population based study of outcomes after evacuation of primary supratentorial intracerebral hemorrhage

Clinical Neurology and Neurosurgery, 2013

Please cite this article in press as: Löppönen P, et al. A population based study of outcomes aft... more Please cite this article in press as: Löppönen P, et al. A population based study of outcomes after evacuation of primary supratentorial intracerebral hemorrhage. Clin Neurol Neurosurg (2013), http://dx.

Research paper thumbnail of Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage

Annals of Neurology, 2015

Objective: There is little evidence to guide treatment strategies for intracerebral hemorrhage on... more Objective: There is little evidence to guide treatment strategies for intracerebral hemorrhage on vitamin K antagonists (VKA-ICH). Treatments utilized in clinical practice include fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC). Our aim was to compare case fatality with different reversal strategies. Methods: We pooled individual ICH patient data from 16 stroke registries in 9 countries (n 5 10 282), of whom 1,797 (17%) were on VKA. After excluding 250 patients with international normalized ratio < 1.3 and/or missing data required for analysis, we compared all-cause 30-day case fatality using Cox regression. Results: We included 1,547 patients treated with FFP (n 5 377, 24%), PCC (n 5 585, 38%), both (n 5 131, 9%), or neither (n 5 454, 29%). The crude case fatality and adjusted hazard ratio (HR) were highest with no reversal (61.7%, View this article online at wileyonlinelibrary.com.