P2Y12 Inhibitors and Mortality in Patients Hospitalized With Intracerebral Hemorrhage

Area of Science:

• Neurology
• Cardiology
• Pharmacology

Background:

• P2Y12 inhibitors are common for atherosclerotic cardiovascular disease.
• Limited data exist on their association with intracerebral hemorrhage (ICH).

Purpose of the Study:

• To compare stroke severity, in-hospital mortality, and functional outcomes in ICH patients based on pre-ICH antiplatelet therapy.
• Investigate outcomes for P2Y12 inhibitor monotherapy, dual antiplatelet therapy (DAPT), aspirin monotherapy, and no antiplatelet therapy.

Main Methods:

• Retrospective cohort study using the Get With The Guidelines-Stroke registry (2013-2021).
• Included 252,691 patients hospitalized with spontaneous ICH.
• Analyzed outcomes including stroke severity (NIHSS), in-hospital mortality, and functional status (mRS).

Main Results:

• P2Y12 inhibitor use (mono or DAPT) was associated with higher rates of severe ICH (NIHSS ≥21) and in-hospital mortality compared to aspirin monotherapy or no antiplatelet therapy.
• Patients on P2Y12 inhibitors had worse functional outcomes at discharge, including lower rates of home discharge and independent ambulation.
• No significant outcome differences were observed between aspirin monotherapy and no antiplatelet therapy groups.

Conclusions:

• Pre-ICH P2Y12 inhibitor use is linked to more severe strokes, increased mortality, and poorer functional recovery.
• Aspirin monotherapy appears safer regarding ICH outcomes compared to P2Y12 inhibitor-based regimens.
• Further research is needed to optimize antiplatelet strategies in patients with ICH risk.