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Antiplatelet therapy contributes to acute deterioration of intracerebral hemorrhage

From the Departments of Cerebrovascular Disease (Drs. Toyoda, Okada, Kamouchi, and Fujimoto) and Neurosurgery (Dr. Inoue), Cerebrovascular Center and Clinical Research Institute, National Kyushu Medical Center, Fukuoka; Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita (Dr. Minematsu); and Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (Dr. Ibayashi).

Address correspondence and reprint requests to Dr. Kazunori Toyoda, Department of Cerebrovascular Disease and Clinical Research Institute, National Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan; e-mail: toyoda{at}hsp.ncvc.go.jp

Objective: The purpose of this study was to examine the effect of antiplatelet therapy on the initial severity and the acute outcome of intracerebral hemorrhage (ICH).

Methods: The authors reviewed records of 251 consecutive patients hospitalized in their cerebrovascular center within 24 hours after onset of ICH.

Results: Fifty-seven patients (23%) had development of ICH during oral antiplatelet therapy. The major indication for antiplatelet therapy was the prevention of stroke recurrence (63%). As compared with patients without antiplatelet therapy, those who received antiplatelet therapy more frequently were aged 70 years or older (60% vs 35%; p < 0.001), had previous symptomatic ischemic stroke (54% vs 7%; p < 0.0001), had diabetes mellitus (26% vs 15%; p < 0.05), and had heart disease (32% vs 8%; p < 0.0001). Antiplatelet therapy was predictive of an increase in the hematoma volume by more than 40% on the second hospital day (hematoma enlargement, odds ratio [OR] 7.67, 95% CI 1.62 to 36.4) and the need for emergent surgical evacuation of the hematoma (OR 3.10, 95% CI 1.18 to 8.15). Antiplatelet therapy was an independent predictor for the occurrence of any of hematoma enlargement, emergent death, or evacuation surgery, which suggests that clinical deterioration occurs into the second hospital day (OR 7.45, 95% CI 2.46 to 22.5).

Conclusions: Antiplatelet therapy seems to contribute to the acute clinical deterioration of intracerebral hemorrhage.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the October 11 issue to find the title link for this article.

Supported in part by the Research Grant for Cardiovascular Diseases (15C-1) from the Japanese Ministry of Health, Labor and Welfare.

Disclosure: The authors report no conflicts of interest.

Received November 11, 2004. Accepted in final form June 14, 2005.

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Neurology 2005 65: 976-977. [Full Text]  

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