Prior antiplatelet therapy is not associated with larger hematoma volume or hematoma growth in intracerebral hemorrhage
Hematoma volume (HV) and hematoma growth (HG) predict mortality and poor outcome in intracerebral hemorrhage (ICH). While the influence of oral anticoagulation on HV, HG and outcome is well established, the effect of prior antiplatelet therapy (APT) remains uncertain. We retrospectively examined data from all patients with acute, primary ICH, and baseline head CT admitted to our department between January 2005 and February 2014. HV were calculated by ABC/2 method. HG was defined as present if HV increased between baseline and follow-up CT ≥ 30% or ≥ 6 mL. We analyzed the influence of APT on HV, HG, and in-hospital mortality using univariate and multivariate analyses. In addition, we used propensity score matching to assess differences in in-hospital mortality rates. From 668 screened patients, 343 had primary ICH and fulfilled all inclusion criteria. APT was present in 99 patients (29%). Baseline median HV was 16 mL (IQR 6–46). HG occurred in 44 of 160 patients with follow-up CT (28%). In-hospital mortality was 10% (n = 36). APT was associated with older age, a mRS score before admission (pre-mRS) of > 2, and presence of cardiovascular comorbidities. We did not find an association between APT and larger baseline HV (p = 0.32), or HG (OR 0.8, 95% CI 0.4–1.9). After propensity score matching for age, pre-mRS, gender, and cardiovascular comorbidities, APT was not associated with higher in-hospital mortality (OR 1.90, 95% CI 0.85–4.24, p = 0.117). This study did not show a higher risk for larger HV, HG, or in-hospital mortality in primary ICH patients with APT.
KeywordsIntracerebral hemorrhage ICH Antiplatelet therapy Aspirin
V. van Ginneken was responsible for the concept, data analysis, and writing of the article. P. Engel was responsible for data analysis and revision of the article. H.J. Audebert, J.B. Fiebach, and C.H. Nolte were responsible for the critical revision of the article. A. Rocco was responsible for the concept, experimental design, and co-writing. We thank all colleagues from the Department of Neurology, Charité CBF for their support and contribution in data acquisition.
Compliance with ethical standards
Conflict of interest
A. Rocco has received honoraria for lectures from Bayer and Ever pharma. C.H. Nolte has received honoraria and/or consultancies from Pfizer, Bayer, BMS, Boehringer Ingelheim, and Sanofi. J. B. Fiebach has received consulting, lecture, and advisory board fees from Perceptive, BioClinica, Boehringer Ingelheim, Cerevast, Brainomix, and Lundbeck as well as a grant from the German Federal Ministry of Education and Research (01EO0801 and 01EO01301). H.J. Audebert has received research grants from Berlin Innovation Fund and German Federal Ministry for Education and Research. H.J. Audebert reports receiving speaker honoraria from Boehringer Ingelheim, EVER Neuropharma, Pfizer, BMS, Strehlows GmbH, and speaker and consultancy honoraria from Lundbeck A/S, Pfizer, Sanofi, and Roche Diagnostics. All remaining authors report no conflicts of interest.
- 4.Foerch C, Sitzer M, Steinmetz H, Neumann-Haefelin T (2006) Pretreatment with antiplatelet agents is not independently associated with unfavorable outcome in intracerebral hemorrhage. Stroke 37(8):2165–2167. https://doi.org/10.1161/01.STR.0000231842.32153.74 CrossRefPubMedGoogle Scholar
- 5.Creutzfeldt CJ, Weinstein JR, Longstreth WT Jr, Becker KJ, McPharlin TO, Tirschwell DL (2009) Prior antiplatelet therapy, platelet infusion therapy, and outcome after intracerebral hemorrhage. J Stroke Cerebrovasc Dis 18(3):221–228. https://doi.org/10.1016/j.jstrokecerebrovasdis.2008.10.007 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Toyoda K, Okada Y, Minematsu K, Kamouchi M, Fujimoto S, Ibayashi S, Inoue T (2005) Antiplatelet therapy contributes to acute deterioration of intracerebral hemorrhage. Neurology 65(7):1000–1004. https://doi.org/10.1212/01.wnl.0000179178.37713.69 CrossRefPubMedGoogle Scholar
- 7.Saloheimo P, Ahonen M, Juvela S, Pyhtinen J, Savolainen ER, Hillbom M (2006) Regular aspirin-use preceding the onset of primary intracerebral hemorrhage is an independent predictor for death. Stroke 37(1):129–133. https://doi.org/10.1161/01.STR.0000196991.03618.31 CrossRefPubMedGoogle Scholar
- 8.Roquer J, Rodriguez Campello A, Gomis M, Ois A, Puente V, Munteis E (2005) Previous antiplatelet therapy is an independent predictor of 30-day mortality after spontaneous supratentorial intracerebral hemorrhage. J Neurol 252(4):412–416. https://doi.org/10.1007/s00415-005-0659-5 CrossRefPubMedGoogle Scholar
- 9.Thompson BB, Bejot Y, Caso V, Castillo J, Christensen H, Flaherty ML, Foerch C, Ghandehari K, Giroud M, Greenberg SM, Hallevi H, Hemphill JC 3rd, Heuschmann P, Juvela S, Kimura K, Myint PK, Nagakane Y, Naritomi H, Passero S, Rodriguez-Yanez MR, Roquer J, Rosand J, Rost NS, Saloheimo P, Salomaa V, Sivenius J, Sorimachi T, Togha M, Toyoda K, Turaj W, Vemmos KN, Wolfe CD, Woo D, Smith EE (2010) Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review. Neurology 75(15):1333–1342. https://doi.org/10.1212/WNL.0b013e3181f735e5 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Ariesen MJ, Claus SP, Rinkel GJ, Algra A (2003) Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke 34(8):2060–2065. https://doi.org/10.1161/01.STR.0000080678.09344.8D CrossRefPubMedGoogle Scholar
- 12.Arima H, Huang Y, Wang JG, Heeley E, Delcourt C, Parsons M, Li Q, Neal B, Chalmers J, Anderson C, Investigators I (2012) Earlier blood pressure-lowering and greater attenuation of hematoma growth in acute intracerebral hemorrhage: interact pilot phase. Stroke 43(8):2236–2238. https://doi.org/10.1161/STROKEAHA.112.651422 CrossRefPubMedGoogle Scholar
- 13.Gebel JM, Sila CA, Sloan MA, Granger CB, Weisenberger JP, Green CL, Topol EJ, Mahaffey KW (1998) Comparison of the abc/2 estimation technique to computer-assisted volumetric analysis of intraparenchymal and subdural hematomas complicating the gusto-1 trial. Stroke 29(9):1799–1801. https://doi.org/10.1161/01.STR.29.9.1799 CrossRefPubMedGoogle Scholar
- 14.Brouwers HB, Chang Y, Falcone GJ, Cai X, Ayres AM, Battey TW, Vashkevich A, KA MN, Valant V, Schwab K, Orzell SC, Bresette LM, Feske SK, Rost NS, Romero JM, Viswanathan A, Chou SH, Greenberg SM, Rosand J, Goldstein JN (2014) Predicting hematoma expansion after primary intracerebral hemorrhage. JAMA Neurol 71(2):158–164. https://doi.org/10.1001/jamaneurol.2013.5433 CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Camps-Renom P, Alejaldre-Monforte A, Delgado-Mederos R, Martínez-Domeño A, Prats-Sánchez L, Pascual-Goñi E, Martí-Fàbregas J (2017) Does prior antiplatelet therapy influence hematoma volume and hematoma growth following intracerebral hemorrhage? Results from a prospective study and a meta-analysis. Eur J Neurol 24(2):302–308. https://doi.org/10.1111/ene.13193 CrossRefPubMedGoogle Scholar
- 18.Baharoglu MI, Cordonnier C, Salman RA, de Gans K, Koopman MM, Brand A, Majoie CB, Beenen LF, Marquering HA, Vermeulen M, Nederkoorn PJ, de Haan RJ, Roos YB (2016) Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (patch): a randomised, open-label, phase 3 trial. Lancet 387(10038):2605–2613. https://doi.org/10.1016/S0140-6736(16)30392-0 CrossRefPubMedGoogle Scholar