Antiplatelet Therapy in Primary Spontaneous and Oral Anticoagulation–Associated Intracerebral Hemorrhage

  • Maximilian I. Sprügel
    From the Department of Neurology (M.I.S., J.B.K., S.T.G., J.A.S., V.D.B., M.H., S.S.R., S.S., H.B.H.), University of Erlangen-Nuremberg, Germany.
  • Joji B. Kuramatsu
    From the Department of Neurology (M.I.S., J.B.K., S.T.G., J.A.S., V.D.B., M.H., S.S.R., S.S., H.B.H.), University of Erlangen-Nuremberg, Germany.
  • Stefan T. Gerner
    From the Department of Neurology (M.I.S., J.B.K., S.T.G., J.A.S., V.D.B., M.H., S.S.R., S.S., H.B.H.), University of Erlangen-Nuremberg, Germany.
  • Jochen A. Sembill
    From the Department of Neurology (M.I.S., J.B.K., S.T.G., J.A.S., V.D.B., M.H., S.S.R., S.S., H.B.H.), University of Erlangen-Nuremberg, Germany.
  • Vanessa D. Beuscher
    From the Department of Neurology (M.I.S., J.B.K., S.T.G., J.A.S., V.D.B., M.H., S.S.R., S.S., H.B.H.), University of Erlangen-Nuremberg, Germany.
  • Manuel Hagen
    From the Department of Neurology (M.I.S., J.B.K., S.T.G., J.A.S., V.D.B., M.H., S.S.R., S.S., H.B.H.), University of Erlangen-Nuremberg, Germany.
  • Sebastian S. Roeder
    From the Department of Neurology (M.I.S., J.B.K., S.T.G., J.A.S., V.D.B., M.H., S.S.R., S.S., H.B.H.), University of Erlangen-Nuremberg, Germany.
  • Hannes Lücking
    Department of Neuroradiology (H.L., T.S., A.D.), University of Erlangen-Nuremberg, Germany.
  • Tobias Struffert
    Department of Neuroradiology (H.L., T.S., A.D.), University of Erlangen-Nuremberg, Germany.
  • Arnd Dörfler
    Department of Neuroradiology (H.L., T.S., A.D.), University of Erlangen-Nuremberg, Germany.
  • Stefan Schwab
    From the Department of Neurology (M.I.S., J.B.K., S.T.G., J.A.S., V.D.B., M.H., S.S.R., S.S., H.B.H.), University of Erlangen-Nuremberg, Germany.
  • Hagen B. Huttner
    From the Department of Neurology (M.I.S., J.B.K., S.T.G., J.A.S., V.D.B., M.H., S.S.R., S.S., H.B.H.), University of Erlangen-Nuremberg, Germany.

抄録

<jats:sec> <jats:title>Background and Purpose—</jats:title> <jats:p>This study determined the influence of concomitant antiplatelet therapy (APT) on hematoma characteristics and outcome in primary spontaneous intracerebral hemorrhage (ICH), vitamin K antagonist (VKA)- and non–VKA oral anticoagulant-associated ICH.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods—</jats:title> <jats:p>Data of retrospective cohort studies and a prospective single-center study were pooled. Functional outcome, mortality, and radiological characteristics were defined as primary and secondary outcomes. Propensity score matching and logistic regression analyses were performed to determine the association between single or dual APT and hematoma volume.</jats:p> </jats:sec> <jats:sec> <jats:title>Results—</jats:title> <jats:p> A total of 3580 patients with ICH were screened, of whom 3545 with information on APT were analyzed. Three hundred forty-six (32.4%) patients in primary spontaneous ICH, 260 (11.4%) in VKA-ICH, and 30 (16.0%) in non–VKA oral anticoagulant-associated ICH were on APT, and these patients had more severe comorbidities. After propensity score matching VKA-ICH patients on APT presented with less favorable functional outcome (modified Rankin Scale score, 0–3; APT, 48/202 [23.8%] versus no APT, 187/587 [31.9%]; <jats:italic>P</jats:italic> =0.030) and higher mortality (APT, 103/202 [51.0%] versus no APT, 237/587 [40.4%]; <jats:italic>P</jats:italic> =0.009), whereas no significant differences were present in primary spontaneous ICH and non–VKA oral anticoagulant-associated ICH. In VKA-ICH, hematoma volume was significantly larger in patients with APT (21.9 [7.4–61.4] versus 15.7 [5.7–44.5] mL; <jats:italic>P</jats:italic> =0.005). Multivariable regression analysis revealed an association of APT and larger ICH volumes (odds ratio, 1.80 [1.20–2.70]; <jats:italic>P</jats:italic> =0.005), which was more pronounced in dual APT and supratherapeutically anticoagulated patients. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>APT does not affect ICH characteristics and outcome in primary spontaneous ICH patients; however, it is associated with larger ICH volume and worse functional outcome in VKA-ICH, presumably by additive antihemostatic effects. Combination of anticoagulation and APT should, therefore, be diligently evaluated and restricted to the shortest possible time frame.</jats:p> </jats:sec>

収録刊行物

  • Stroke

    Stroke 49 (11), 2621-2629, 2018-11

    Ovid Technologies (Wolters Kluwer Health)

被引用文献 (1)*注記

もっと見る

詳細情報 詳細情報について

問題の指摘

ページトップへ