Effect of On-Admission Antiplatelet Treatment on Patients with Cerebral Hemorrhage

Abstract

Background: Antiplatelet treatment remains the first choice for primary and secondary prevention of vascular diseases; even so, expected benefits may be offset by risk of bleeding, particularly cerebral hemorrhage. The aim of this study was to assess the influence of antiplatelet treatment on clinical outcome at hospital discharge. Materials and Methods: Consecutive patients with first-ever stroke due to a primary intraparenchymal hemorrhage were prospectively identified over a 4-year period (2000–2003). Data on hemorrhage location, vascular risk factors, and antiplatelet and anticoagulant treatment were collected. At discharge, outcome was measured using the modified Rankin Scale (disabling stroke ≧3). Patients treated with anticoagulant therapy were excluded from the study. Results: Of 457 consecutive patients with cerebral hemorrhage, 94 (20.5%) had been taking antiplatelet agents. The treated patients (mean age for antiplatelet group 78.9 ± 9.0 years) were older than the nontreated patients (73.8 ± 9.4, p = 0.02). In-hospital mortality was 23.4 and 23.1% (p = n.s.) for patients who had been taking antiplatelet agents or no treatment. Poor outcome at discharge was found in 52.1 and 59.7% (p = n.s.), respectively. Univariate analysis showed that age and coma at admission were predictors of disability at discharge, but antiplatelet treatment was not. Additionally, age and coma were shown to be determinants of disability at discharge after multivariate analysis: OR 1.03 per year (95% CI: 1.018–1.049), p < 0.001 and OR 1.68 (95% CI: 1.138–2.503), p = 0.009, respectively. Conclusions: Hemorrhagic stroke continues to be responsible for a high percentage of disability and death. Furthermore, it was seen here that functional outcome was independent of previous antiplatelet treatment.

The Increase of The Mean Platelet Volume in Patients With Intracerebral Haemorrhage

“…Antitrombosit tedavi alanlarda İSK riskinin daha fazla olduğu ve bu hastalarda mortalitenin daha yüksek olduğu iddia edilmiştir (15)(16)(17). Sansing ve ark.…”

The role of anticoagulants, antiplatelet agents, and their reversal strategies in the management of intracerebral hemorrhage

“…8,10,11,21,23,25,36,57,60,70 Diffi culty or delay in the reversal of the effects of anticoagulant medications can result in hematoma expansion or delayed surgical evacuation. By comparison, reversal of antiplatelet medication in a similar setting still has unproven benefit.…”

“…8,10,11,25,37,57,60,70 The risk for ICH appears to be dose dependent with aspirin, the most studied agent, but exists with other agents as well. 46 demonstrated that the chance of undergoing a craniotomy for ICH, when controlling for size of hemorrhage and location, was increased with pre-event aspirin use and platelet inhibition as determined by VerifyNow ASA.…”

Prior Antiplatelet Use Does Not Affect Hemorrhage Growth or Outcome After Ich 2

“…Finally, a prospective study performed at two hospitals including 457 patients reported no difference in the proportion of patients with mRS 4 or 5 at discharge between the antiplatelet users and nonusers. 16 In a related study, the pooled analysis of the Chinese Acute Stroke Trial and the International Stroke Trial found that 773 (2%) patients were randomized to aspirin or placebo after an ICH because a CT scan was not required for entry into the trial. 25 There was no increased risk of death in these patients.…”

“…Multiple articles with different study designs, exclusion criteria, and numbers of patients have reported conflicting results. 11,[14][15][16][17][18][19][20][21] The purpose of this study was to use the data from a large prospective clinical trial with predefined inclusion criteria, standardized timing of imaging acquisition and blinded analysis of volumes, and standardized outcome assessment to analyze the effect of prior antiplatelet medication use on hemorrhage and edema expansion and functional outcome.…”