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Preadmission Antiplatelet Use and Associated Outcomes and Costs Among ICU Patients With Intracranial Hemorrhage
Shannon M Fernando1,2, Garrick Mok2, Bram Rochwerg3,4
1Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada.
Insights
Preadmission oral antiplatelet use did not increase in-hospital mortality or costs for patients with intracranial hemorrhage admitted to the ICU. These findings suggest no adverse impact on outcomes for these patients.
Area of Science:
- Neurology
- Critical Care Medicine
- Pharmacology
Background:
- Intracranial hemorrhage (ICH) patients are frequently admitted to the intensive care unit (ICU).
- Increasing use of oral antiplatelet agents necessitates understanding their impact on ICH outcomes.
- The effect of preadmission oral antiplatelet use on ICU patients with ICH remains unclear.
Purpose of the Study:
- To evaluate the association between preadmission oral antiplatelet use and outcomes in ICU patients with ICH.
- To assess the impact on in-hospital mortality, resource utilization, and hospital costs.
Main Methods:
- Retrospective analysis of a prospectively collected registry (2011-2016) of adult ICU patients with ICH.
- Patients were categorized based on preadmission oral antiplatelet use; anticoagulant users were excluded.
- In-hospital mortality analyzed using multivariable logistic regression; costs analyzed using a generalized linear model.
Main Results:
- Of 720 ICH patients, 107 (14.9%) used oral antiplatelets prior to ICU admission.
- Oral antiplatelet use was not associated with in-hospital mortality (aOR: 1.31; 95% CI: 0.93-2.22).
- No association found between oral antiplatelet use and total hospital costs (aROM: 0.92; 95% CI: 0.82-1.02).
Conclusions:
- Preadmission oral antiplatelet use is not linked to increased in-hospital mortality in ICU patients with ICH.
- Hospital costs were not significantly associated with preadmission oral antiplatelet use in this cohort.
- Findings offer important prognostic insights for clinicians managing ICH patients on antiplatelet therapy.
Introduction:
Patients with intracranial hemorrhage (including intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic hemorrhage) are commonly admitted to the intensive care unit (ICU). Although indications for oral antiplatelet agents are increasing, the impact of preadmission use on outcomes in patients with intracranial hemorrhage admitted to the ICU is unknown. We sought to evaluate the association between preadmission oral antiplatelet use, in-hospital mortality, resource utilization, and costs among ICU patients with intracranial hemorrhage.
Methods:
We retrospectively analyzed a prospectively collected registry (2011-2016) and included consecutive adult patients from 2 hospitals admitted to ICU with intracranial hemorrhage. Patients were categorized on the basis of preadmission oral antiplatelet use. We excluded patients with preadmission anticoagulant use. The primary outcome was in-hospital mortality and was analyzed using a multivariable logistic regression model. Contributors to total hospital cost were analyzed using a generalized linear model with log link and gamma distribution.
Results:
Of 720 included patients with intracranial hemorrhage, 107 (14.9%) had been using an oral antiplatelet agent at the time of ICU admission. Oral antiplatelet use was not associated with in-hospital mortality (adjusted odds ratio: 1.31 [95% confidence interval [CI]: 0.93-2.22]). Evaluation of total costs also revealed no association with oral antiplatelet use (adjusted ratio of means [aROM]: 0.92 [95% CI: 0.82-1.02, P = .10]). Total cost among patients with intracranial hemorrhage was driven by illness severity (aROM: 1.96 [95% CI: 1.94-1.98], P < .001), increasing ICU length of stay (aROM: 1.05 [95% CI: 1.05-1.06], P < .001), and use of invasive mechanical ventilation (aROM: 1.76 [95% CI: 1.68-1.86], P < .001).
Conclusions:
Among ICU patients admitted with intracranial hemorrhage, preadmission oral antiplatelet use was not associated with increased in-hospital mortality or hospital costs. These findings have important prognostic implications for clinicians who care for patients with intracranial hemorrhage.
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