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ARTICLES: K. Toyoda, Y. Okada, K. Minematsu, M. Kamouchi, S. Fujimoto, S. Ibayashi, and T. Inoue Antiplatelet therapy contributes to acute deterioration of intracerebral hemorrhage Neurology 2005; 65: 1000-1004 [Abstract] [Full text] [PDF]

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Reply from the Author

Kazunori Toyoda   (1 February 2006)

Antiplatelet therapy contributes to acute deterioration of intracerebral hemorrhage

Ka Sing Wong   (1 February 2006)

Reply from the Author 1 February 2006
Kazunori Toyoda, Department of Cerebrovascular Disease, National Kyushu Medical Center 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan Send Correspondence to journal: Re: Reply from the Author toyoda{at}hsp.ncvc.go.jp Kazunori Toyoda	I thank Dr. Wong for his interest and comments on our study. [1] In contrast with our results, he points out that prior antiplatelet use did not contribute to the in-patient mortality in his study based on 783 patients with intracerebral hemorrhage (ICH). [2] This discrepancy appears to be mainly due to difference in underlying profiles of patients between studies. First, there is a large difference in frequency of patients taking antiplatelet agents (23% in our study vs. 4.3% in his study). A recent study reported that 32% of the patients with ICH were taking antiplatelets. [5] In addition, our study seems to include older, hypertensive, and diabetic patients than his study (see Table E-1 on the Web site of Ref 1). In a recent study, prior antiplatelet use was independently associated with 30-day mortality of patients with first ever supratentorial ICH. [6] Dr. Wong et al [3] also reported that prior antiplatelet use increased prevalence of lobar hemorrhage from 10 to 33%. This predilection was not evident in our study (see Table E-2 on the Web site of Ref 1). I am interested in asymptomatic microbleeds as a predictor for aspirin-associated ICH. [4] In our study, we did not examine microbleeds on MRI in all the patients. I agree that we should be cautious in antithrombotic therapy for patients with multiple microbleeds on MRI. References 1. Toyoda K, Okada Y, Minematsu K, et al. Antiplatelet therapy contributes to acute deterioration of intracerebral hemorrhage. Neurology 2005;65:1000-1004. 2. Wong KS. Risk factors for early death in acute ischemic stroke and intracerebral hemorrhage: A prospective hospital-based study in Asia. Asian Acute Stroke Advisory Panel. Stroke 1999;30:2326-2330. 3. Wong KS, Mok V, Lam W, et al. Aspirin-associated intracerebral hemorrhage: clinical and radiologic features. Neurology 2000;54:2298-2301. 4. Wong KS, Chan YL, Liu JY, Gao S, Lam WW. Asymptomatic microbleeds as a risk factor for aspirin-associated intracerebral hemorrhages. Neurology 2003;60:511-513. 5. Rosand J, Eckman MH, Knudsen KA, Singer DE, Greenberg SM. The effect of warfarin and intensity of anticoagulation on outcome of intracerebral hemorrhage. Arch Intern Med 2004;164:880-884. 6. Roquer J, Rodriguez Campello A, et al. Previous antiplatelet therapy is an independent predictor of 30-day mortality after spontaneous supratentorial intracerebral hemorrhage. J Neurol 2005; 252: 412-416. Disclosure: The author reports no conflicts of interest.
Antiplatelet therapy contributes to acute deterioration of intracerebral hemorrhage 1 February 2006
Ka Sing Wong, Chinese University of Hong Kong Prince of Wales Hospital, Shatin , NT, Hong Kong SAR, CHINA Send Correspondence to journal: Re: Antiplatelet therapy contributes to acute deterioration of intracerebral hemorrhage ks-wong{at}cuhk.edu.hk Ka Sing Wong	Toyoda et al reported that of 251 patients with intracerebral hemorrhage (ICH), 57 patients were taking an antiplatelet agent. [1] They found that prior antiplatelet agent use was associated with hematoma enlargement, emergent death, or evacuation surgery. This finding conflicts with a previous Asia-wide study of 783 ICH patients. [2] In that study, prior antiplatelet use was recorded in 34 patients and was associated with a non-significant reduced odds of in-patient mortality of 0.42 (95% confidence interval 0.13-1.32). The authors did not present the detailed locations of the ICH. Antiplatelet associated ICH is more likely to be lobar [3], which may partially explain why evacuation surgery was more likely in this group of patients. Furthermore, microbleeds detected by MRI have been found to be a risk factor for antiplatelet associated ICH. [4] If the authors could provide data on these aspects, it would enhance our understanding of the pathogenesis and prognosis of antiplatelet associated ICH. Disclosure: The author reports no conflicts of interest.