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Aspirin-associated intracerebral hemorrhage: clinical and radiologic features
1Departments of Medicine & Therapeutics, the Chinese University of Hong Kong, Shatin.
Insights
Aspirin use is linked to a higher risk of lobar intracerebral hemorrhage (ICH) compared to non-aspirin users. This suggests different underlying pathology for aspirin-associated ICH, warranting further investigation into aspirin
Area of Science:
- Neurology
- Clinical Medicine
- Pharmacology
Background:
- Aspirin use, while beneficial for vascular disease prevention, increases the risk of intracerebral hemorrhage (ICH).
- Understanding the specific characteristics of ICH in aspirin users is crucial for risk-benefit assessment.
Purpose of the Study:
- To delineate the clinical and radiologic features of intracerebral hemorrhage (ICH) specifically in patients using aspirin.
- To compare ICH characteristics between aspirin users and non-users.
Main Methods:
- A retrospective analysis of a stroke registry (1993-1998) identified patients with CT-confirmed ICH.
- Aspirin users with ICH were compared to age- and sex-matched controls who did not use aspirin.
Main Results:
- Fifty-eight aspirin users and 116 non-users were included in the comparison.
- Lobar hematoma was significantly more frequent in aspirin users (32.8%) than in controls (10.3%) (p = 0.002).
- Aspirin was primarily prescribed for prior cerebrovascular disease (64%), with a small proportion (5 patients) having a history of ICH.
Conclusions:
- The higher incidence of lobar ICH in aspirin users suggests a distinct pathophysiology compared to spontaneous ICH in non-users.
- Further research is needed to evaluate the nuanced risks and benefits of aspirin in specific patient subgroups prone to both thrombotic and hemorrhagic events.
Objective:
To identify the clinical and radiologic features of intracerebral hemorrhage (ICH) in aspirin users.
Background:
Although the benefits of aspirin outweigh its hemorrhagic risks for patients at high risk of vascular diseases, prolonged use of aspirin is associated with an increased risk of ICH.
Methods:
The authors enrolled consecutive patients with acute stroke who were admitted to a regional hospital from 1993 to 1998 into a stroke registry. From this registry, they identified all stroke patients who had ICH confirmed by CT scan and then selected those taking regular aspirin before ICH as the study group. For each study patient, they selected the immediate next two patients with ICH but not taking aspirin as controls.
Results:
The authors identified 58 aspirin users and 1193 nonusers among all patients hospitalized for ICH. From the group of nonusers, they selected 116 patients as controls. The locations of the hematoma were different (p = 0.002), with more lobar hematoma in the aspirin group (32.8%) than in the control group (10.3%). Prior cerebrovascular disease was the reason for taking aspirin in 37 (64%) patients but five patients had prior ICH.
Conclusions:
The propensity for lobar hematoma in aspirin-associated ICH suggests its pathology may be somewhat different from spontaneous ICH among nonaspirin users. Further research to examine the risks and benefits of aspirin use in certain subgroups at risk of both thrombotic and hemorrhagic events is needed.