Prognosis of Intracerebral Hemorrhage Related to Antithrombotic Use
Autor: | Trine Apostolaki-Hansson, Jesper Petersson, Teresa Ullberg, Bo Norrving, Mats Pihlsgård |
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Rok vydání: | 2021 |
Předmět: |
Male
medicine.medical_specialty Neurology Administration Oral Fibrinolytic Agents Antithrombotic medicine Humans Registries cardiovascular diseases Stroke Aged Cerebral Hemorrhage Proportional Hazards Models Aged 80 and over Sweden Advanced and Specialized Nursing Intracerebral hemorrhage business.industry Anticoagulants Middle Aged Prognosis medicine.disease nervous system diseases Treatment Outcome Multivariate Analysis Emergency medicine Oral anticoagulant Regression Analysis Female Observational study Neurology (clinical) Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors |
Zdroj: | Stroke. 52:966-974 |
ISSN: | 1524-4628 0039-2499 |
Popis: | Background and Purpose: To date, large studies comparing mortality and functional outcome of intracerebral hemorrhage (ICH) during oral anticoagulant (OAC), antiplatelet, and nonantithrombotic use are few and show discrepant results. Methods: We used data on 13 291 patients with ICH registered in Riksstroke between 2012 and 2016 to compare 90-day mortality and functional outcome following OAC-related ICH (n=2300), antiplatelet-related ICH (n=3637), and nonantithrombotic ICH (n=7354). Univariable and multivariable Cox regression analyses, with adjustment for relevant confounders, were used to compare 90-day mortality. Early (≤24 hours and 1–7 days) and late (8–90 days) mortality was also studied in subgroup analyses. Univariable and multivariable 90-day functional outcome, based on self-reported modified Rankin Scale, was determined using logistic regression. Results: Patients with antithrombotic treatment were more often prestroke dependent, older, and had a larger comorbidity burden compared with patients without antithrombotic treatment. At 90 days, antiplatelet and OAC were associated with an increased death rate in multivariable analysis (antiplatelet ICH: hazard ratio, 1.23 [95% CI, 1.14–1.33]; OAC ICH: hazard ratio, 1.40 [95% CI, 1.26–1.57]) compared with nonantithrombotic ICH (reference). OAC ICH and antiplatelet ICH were associated with higher risk of early mortality (≤24 hours: OAC ICH: hazard ratio, 1.93 [95% CI, 1.57–2.38]; antiplatelet ICH: hazard ratio, 1.32 [95% CI, 1.13–1.54]). In multivariable analysis, the odds ratios for the association of antiplatelet and OAC treatment on functional dependency (modified Rankin Scale score, 3–5) at 90 days were nonsignificant (antiplatelet: odds ratio, 1.07 [95% CI, 0.92–1.24]; OAC: odds ratio, 0.96 [95% CI, 0.76–1.22]). Conclusions: In this large observational study, we found that 90-day mortality outcome was worse not only in OAC ICH but also in antiplatelet ICH, compared with patients with nonantithrombotic ICH. Antiplatelet ICH is common and is a serious condition with poor clinical outcome. Further studies are, therefore, warranted in determining the appropriate clinical management of these patients. |
Databáze: | OpenAIRE |
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