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Prescribing antiplatelet medicine and subsequent events after intracerebral hemorrhage

Robert W V Flynn1, Thomas M MacDonald, Gordon D Murray

  • 1University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.

Stroke
|October 16, 2010
PubMed

Insights

Antiplatelet prescribing is common after intracerebral hemorrhage (ICH). Despite perceived contraindications, antiplatelet use did not significantly increase the risk of recurrent ICH or other adverse events in this study.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Intracerebral hemorrhage (ICH) survivors often have indications for antiplatelet therapy.
  • Antiplatelet medications are frequently considered contraindicated post-ICH.
  • This study examines antiplatelet use and outcomes in ICH patients.

Purpose of the Study:

  • To describe antiplatelet prescribing patterns after ICH.
  • To determine the rate of subsequent adverse events, including recurrent ICH and ischemic events.
  • To assess the safety and impact of antiplatelet therapy in ICH survivors.

Main Methods:

  • Observational study using record-linkage of stroke cohort and prescribing data (1994-2005).
  • Follow-up of ICH survivors from discharge to assess outcomes.
  • Analysis of recurrent ICH, ischemic stroke, and composite ischemic events using Cox models.

Main Results:

  • 28.8% of 417 ICH survivors received antiplatelet therapy, often delayed post-discharge.
  • Rates per 1000 patient-years: recurrent ICH (9.7), ischemic stroke (20.6), ischemic stroke/MI (28.7).
  • Antiplatelet exposure showed no significant increase in recurrent ICH risk (HR 1.07) or other adverse events.

Conclusions:

  • Antiplatelet prescribing is prevalent post-ICH, contrary to common perception.
  • Subsequent ischemic events are more frequent than recurrent ICH.
  • Antiplatelet use appears safe in ICH survivors, with no significant increase in recurrent ICH risk.
Abstract

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