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Published on: July 3, 2014
Association Between Previous Use of Antiplatelet Therapy and Intracerebral Hemorrhage Outcomes
Nadeem I Khan1, Fazeel M Siddiqui2, Joshua N Goldstein2
1From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (N.I.K., F.M.S.); Department of Emergency Medicine (J.N.G.), Department of Neurology (L.H.S.), Massachusetts General Hospital, and Brigham and Women's Hospital Heart and Vascular Center (D.L.B.), Harvard Medical School, Boston; Duke Clinical Research Institute, Durham, NC (M.C., Y.X., R.A.M., E.D.P.); Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke University Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.); Department of Medicine, Stanford University School of Medicine, CA (P.A.H.); Department of Medicine, Ronald-Reagan UCLA Medical Center (G.C.F.); and Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada (E.E.S.). nadeem.israr.khan@gmail.com.
Background And Purpose:
Although the use of antiplatelet therapy (APT) is associated with the risk of intracerebral hemorrhage (ICH), there are limited data on prestroke APT and outcomes, particularly among patients on combination APT (CAPT). We hypothesized that the previous use of antiplatelet agents is associated with increased mortality in ICH.
Methods:
We analyzed data of 82 576 patients with ICH who were not on oral anticoagulant therapy from 1574 Get with the Guidelines-Stroke hospitals between October 2012 and March 2016. Patients were categorized as not on APT, on single-APT (SAPT), and CAPT before hospital presentation with ICH. We described baseline characteristics, comorbidities, hospital characteristics and outcomes, overall and stratified by APT use.
Results:
Before the diagnosis of ICH, 65.8% patients were not on APT, 29.5% patients were on SAPT, and 4.8% patients were on CAPT. There was an overall modest increased in-hospital mortality in the APT group versus no APT group (24% versus 23%; adjusted odds ratio, 1.05; 95% confidence interval, 1.01-1.10). Although patients on SAPT and CAPT were older and had higher risk profiles in terms of comorbidities, there was no significant difference in the in-hospital mortality among patients on SAPT versus those not on any APT (23% versus 23%; adjusted odds ratio, 1.01; 95% confidence interval, 0.97-1.05). However, in-hospital mortality was higher among those on CAPT versus those not on APT (30% versus 23%; adjusted odds ratio, 1.50; 95% confidence interval, 1.39-1.63).
Conclusions:
Our study suggests that among patients with ICH, previous use of CAPT, but not SAPT, was associated with higher risk for in-hospital mortality.
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