Liver cirrhosis is associated with an increased risk of stroke, researchers from New York report in JAMA Neurology.

A retrospective review has found that 1.0 per cent of about 1.6m people had cirrhosis. The mean age of those with cirrhosis was 74.1 years, with 46.6 per cent female.

During the mean follow-up of 4.3 years, the annual incidence of hospitalisations for stroke was 2.17 and 1.11 per cent in those with and without cirrhosis respectively.

Ischaemic stroke (1.80 and 0.96 per cent), intracerebral haemorrhage (0.31 and 0.14 per cent) and subarachnoid haemorrhage (0.13 and 0.04 per cent) were also commoner in those with, than those without, cirrhosis.

After adjusting for demographics and risk factors, patients with cirrhosis were 40 per cent more likely to have a stroke. Cirrhosis was assoc-iated with a doubling of the risk of intracerebral and subarachnoid haemorrhage, as well as a 30 per cent increased likelihood of ischaemic stroke.

The authors suggest that the “mixed coagulopathy” associated with cirrhosis might account for the link. For instance, cirrhosis can be associated with bleeding complications, such as portal hypertensive haemorrhage in the gastrointestinal tract, but it also seems to be associated with venous thromboembolism.

doi:10.1001/jamaneurol.2017.0923

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