Research Shows Smoking Status Is a Risk Factor for Hematoma Expansion


The findings suggest that cigarette smoking is an independent predictor for the expansion of hematoma, although smoking status does not cause a difference in mortality.

New study findings analyzing previous data helped determine the risk factors for ischemic and hemorrhagic stroke associated with cigarette smoking has. The researchers expanded the Antihypertensive Treatment at Acute Cerebral Hemorrhage-2 trial (ATACH) to find the impact cigarette smoking status has for hematoma expansion on individuals with intracerebral hemorrhage (ICH).

World No Tobacco Day Concept Stop Smoking.tobacco cigarette butt on the floor | Image credit: Pcess609 -

Cigarette butt on the floor | Image credit: Pcess609 -

According to the study, the researchers conducted a post hoc trial that was an international, randomized, open-label clinical trial designed to identify the effectiveness of rapidly lowering the systolic blood pressure (SPB) for individuals with acute spontaneous intracerebral hemorrhage (ICH).

The previous trial included patient demographic elements, such as age, race, sex, ethnicity, and smoking status. The smoking status defined current smokers as individuals who were actively smoking during the trial; former smokers as individuals who smoked regularly in the past, but not throughout the trial; ever smokers as individuals who are either current and former smokers; and never smokers. The study confirmed that the demographics were also factored into the post hoc study.

According to the study, ICH accounts for 10% to 20% of all strokes. Various studies have been conducted to confirm that cigarette smoking, especially in young smokers, is a high risk for ICH, although the data found for smoking while in recovery does not match.

“Some studies in patients with ICH have found no difference in clinical outcomes based on smoking history. However, other studies have observed negative effects of tobacco use on ICH outcomes, including increased hematoma expansion and worse functional outcomes. Therefore, a knowledge gap exists about the impact of cigarette smoking on the clinical outcomes of ICH,” wrote the study authors.

To complete the trial, 914 individuals with initial ICH volume <60 mL, Glasgow Coma Scale (GCS) scores of >4, and systolic blood pressure (SBP) ≥180 mm Hg were placed into a randomized trial. Patients were assigned in a 1:1 ratio to either intensive SBP lowering or standard SBP lowering. The smoking status for all 914 participants was known.

“The following binary outcome variables were analyzed: 90‐day mRS score of 0 to 3 versus 4 to 6, 90‐day mRS score of 0 to 1 versus 2 to 6, hematoma expansion, neurologic deterioration, presence of any serious adverse event within 72 hours after randomization that was considered by the site investigator to be related to treatment, and death within 3 months after randomization,” said the study authors.

The results showed that males were more likely to ever smoke than females in the trial, with 80.6% males and 19.4% females reporting smoking at any time. Out of the 914 individuals, 439 were ever smokers, 264 were current smokers, and 175 were former smokers. The age of current smokers was younger than both ever and former smokers. However, ever smokers had a higher chance of hematoma expansion compared with never smokers. Despite this, there was no difference in death and disability due to different smoking status.

The findings suggest that cigarette smoking is an independent predictor for the expansion of hematoma, although smoking status does not cause a suggestive difference in mortality.


Cigarette Smoking as a Risk Factor for Hematoma Expansion in Primary Intracerebral Hemorrhage: Analysis From a Randomized Clinical Trial. JAHA. News release. July 31, 2023. Accessed August 3, 2023.

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