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Published on: October 2, 2014
Hematoma Expansion Shift Analysis to Assess Acute Intracerebral Hemorrhage Treatments
Vignan Yogendrakumar1, Tim Ramsay1, Bijoy K Menon1
1From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine, Neurology (V.Y., D.D.), and School of Epidemiology and Public Health (T.R., D.D.), University of Ottawa and Ottawa Hospital Research Institute (T.R., D.D.), Ontario; Department of Clinical Neurosciences, Radiology, and Community Health Sciences (B.K.M.), Cumming School of Medicine and the Hotchkiss Brain Institute (B.K.M.), University of Calgary, Alberta, Canada; Zeenat Qureshi Stroke Institute (A.L.Q.), University of Missouri, Columbia; and David Geffen School of Medicine Comprehensive Stroke Center (J.L.S.), University of California Los Angeles.
Objective:
Hematoma expansion (HE) is commonly analyzed as a dichotomous outcome in intracerebral hemorrhage (ICH) trials. In this proof-of-concept study, we propose an HE shift analysis model as a method to improve the evaluation of candidate ICH therapies.
Methods:
Using data from the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) trial, we performed HE shift analysis in response to intensive blood pressure lowering by generating polychotomous strata based on previously established HE definitions, percentile/absolute quartiles of hematoma volume change, and quartiles of 24-hour follow-up hematoma volumes. The relationship between blood pressure treatment and HE shift was explored with proportional odds models.
Results:
The primary analysis population included 863 patients. In both treatment groups, approximately one-third of patients exhibited no HE. With the use of a trichotomous HE stratification, the highest strata of ≥33% revealed a 5.8% reduction in hematoma growth for those randomized to intensive therapy (adjusted odds ratio [aOR] 0.77, 95% confidence interval [CI] 0.60-0.99). Using percentile quartiles of hematoma volume change, we observed a favorable shift to reduce growth in patients treated with intensive therapy (aOR 0.73, 95% CI 0.57-0.93). Similarly, in a tetrachotomous analysis of 24-hour follow-up hematoma volumes, shifts in the highest stratum (>21.9 mL) were most notable.
Conclusions:
Our findings suggest that intensive blood pressure reduction may preferentially mitigate growth in patients at risk of high volume HE. A shift analysis model of HE provides additional insights into the biological effects of a given therapy and may be an additional way to assess hemostatic agents in future studies.
Trial Registration Information:
ClinicalTrials.gov Identifier:NCT01176565.
