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Prior antiplatelet use does not affect hemorrhage growth or outcome after ICH

From the University of Pennsylvania (L.H.S., S.R.M., B.L.C., S.E.K.), Philadelphia; Nevada Neurosciences Institute at Sunrise (S.N.C.), Las Vegas; and University of California (P.D.L.), San Diego.

Address correspondence and reprint requests to Dr. Lauren H. Sansing, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3 W Gates, Philadelphia, PA 19104 sansingl{at}uphs.upenn.edu

Objective: To examine whether antiplatelet medication use at onset of intracerebral hemorrhage (ICH) is associated with hemorrhage growth and outcome after spontaneous ICH using a large, prospectively collected database from a recent clinical trial.

Methods: The Cerebral Hemorrhage and NXY-059 Treatment trial was a randomized, placebo-controlled trial of NXY-059 after spontaneous ICH. We analyzed patients in the placebo arm, and correlated antiplatelet medication use at the time of ICH with initial ICH volumes, ICH growth in the first 72 hours, and modified Rankin Score at 90 days. Patients on oral anticoagulation were excluded.

Results: There were 282 patients included in this analysis, including 70 (24.8%) who were taking antiplatelet medications at ICH onset. Use of antiplatelet medications at ICH onset had no association with the volume of ICH at presentation, growth of ICH at 72 hours, initial edema volume, or edema growth. In multivariable analysis, there was no association of use of antiplatelet medications with any hemorrhage expansion (relative risk [RR] 0.85 [upper limit of confidence interval (UCI) 1.03], p = 0.16), hemorrhage expansion greater than 33% (RR 0.77 [UCI 1.18], p = 0.32), or clinical outcome at 90 days (odds ratio 0.67, 95% confidence interval 0.39–1.14, p = 0.14).

Conclusions: Use of antiplatelet medications at intracerebral hemorrhage (ICH) onset is not associated with increased hemorrhage volumes, hemorrhage expansion, or clinical outcome at 90 days. These findings suggest that attempts to reverse antiplatelet medications after ICH may not be warranted.

Abbreviations: CHANT = Cerebral Hemorrhage and NXY-059 Treatment; CI = confidence interval; ICH = intracerebral hemorrhage; IQR = interquartile range; mRS = modified Rankin Scale; RR = relative risk; UCI = upper limit of confidence interval.

Editorial, page 1376

e-Pub ahead of print on January 7, 2009, at www.neurology.org.

Funded by NIH T32 HL007954-07 (L.H.S.).

Disclosure: The authors report no disclosures.

Received February 25, 2008. Accepted in final form October 31, 2008.

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Evidence against rapid reversal of antiplatelet medications in acute intracerebral hemorrhage

Joseph P. Broderick
Neurology 2009 72: 1376-1377. [Full Text] [PDF]

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				J. P. Broderick Evidence against rapid reversal of antiplatelet medications in acute intracerebral hemorrhage Neurology, April 21, 2009; 72(16): 1376 - 1377. [Full Text] [PDF]

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