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Antiplatelet use after intracerebral hemorrhage

From the Stroke Service and Neurology Clinical Trials Unit, Department of Neurology, Massachusetts General Hospital, Boston.

Address correspondence and reprint requests to Dr Smith, VBK 802, MGH Stroke Service, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114; e-mail: eesmith{at}partners.org

Background: Survivors of intracerebral hemorrhage are at risk for recurrent intracerebral hemorrhage and ischemic cardiovascular and cerebrovascular disease.

Objective: To determine whether antiplatelet therapy increases the risk of recurrent intracerebral hemorrhage.

Methods: The authors reviewed data from consecutive survivors of primary intracerebral hemorrhage enrolled in a single-center prospective cohort study. Survivors were followed by telephone interview; recurrent intracerebral hemorrhage and post–index antiplatelet agent use and duration were recorded. Cox proportional hazards models was used with antiplatelet agent exposure as a time-dependent variable to assess the effect of antiplatelet agent use on recurrent intracerebral hemorrhage, stratified by lobar and deep hemispheric location.

Results: Recurrent intracerebral hemorrhage was more common in survivors of lobar hemorrhage compared with survivors of deep hemorrhage (cumulative 2-year rate 22% vs 4%; p = 0.007). Antiplatelet agents were prescribed in 22% of intracerebral hemorrhage survivors (27/127 lobar, 19/80 deep hemispheric), most commonly for prevention of ischemic heart disease. Antiplatelet agent use was not associated with intracerebral hemorrhage recurrence in survivors of either lobar hemorrhage (hazard ratio [HR] 0.8, 95% CI 0.3 to 2.3, p = 0.73) or of deep hemorrhage (HR 1.2, 95% CI 0.1 to 14.3, p = 0.88).

Conclusion: Antiplatelet agent use is relatively common following intracerebral hemorrhage but did not appear to be associated with a large increased risk of intracerebral hemorrhage recurrence in this observational study.

Editorial, see page 162

Disclosure: The authors report no conflicts of interest.

Received June 30, 2005. Accepted in final form October 4, 2005.

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