Antiplatelet Use Linked to Hematoma Growth, Outcomes in Intracerebral Hemorrhage

Prior antiplatelet therapy is related to larger hematoma volume in patients with intracerebral hemorrhage (ICH), and may influence hematoma growth, according to data published in the European Journal of Neurology.¹

Several factors contribute to prognosis during ICH,^2-4 with complications such as hematoma growth associated with poor outcomes.^5,6 However, it is not clear how prior antiplatelet therapy affects hematoma volume and growth and overall outcomes.

In this study, researchers conducted a prospective analysis of clinical and radiological data from 223 patients (mean age 72.5 years, 54.3% men) with ICH. Of those, 74 patients had prior antiplatelet use, including aspirin (n=58), triflusal (n=6), clopidogrel (n=8), aspirin plus clopidogrel (n=1) or aspirin plus dipyridamole (n=1).

Patients with prior antiplatelet use were more likely than their counterparts to have previously been treated with statins, and to have a history of additional conditions, which included hypertension, diabetes, hypercholesterolemia, ischemic stroke, and coronary artery disease..

After linear regression, prior antiplatelet use was found to be independently associated with greater baseline hematoma volume. In this cohort, prior antiplatelet use was not found to influence hematoma growth; however a meta-analysis of pooled data found an increased frequency of hematoma growth in patients with prior antiplatelet use (odds ratio [OR] 1.85; 95% confidence interval [CI], 1.37–2.5). Although it was found to be non-significant, the authors noted that patients with prior antiplatelet use did have worse outcomes at follow-up (P=.06).

Notably, analysis showed that the association with antiplatelet use was significant for deep ICH, but not lobar. “A possible explanation is that lobar ICHs are usually larger and, thus, a larger sample size would be needed to test the effect of APT,” the authors wrote.

The authors continued, “It is important to highlight that patients

in the APT group were older and had more comorbidity, which might partly explain the poor outcome. Currently it remains unclear whether APT influences mortality and functional outcome.”

Future studies in which patients would be selected based on platelet activity might help determine whether antiplatelet use leads to worse ICH outcomes, the authors suggested.

The authors report no disclosures.

References

1. Camps-renom P, Alejaldre-monforte A, Delgado-mederos R, et al. Does prior antiplatelet therapy influence hematoma volume and hematoma growth following intracerebral hemorrhage? Results from a prospective study and a meta-analysis. Eur J Neurol. 2016; doi:10.1111/ene.13193.
2. Leira R, D_avalos A, Silva Y, et al. Early neurologic deterioration in intracerebral hemorrhage: predictors and associated factors. Neurology. 2004; 63: 461–467.
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5. Davis SM, Broderick J, Hennerici M, et al. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology. 2006; 66:1175–1181.
6. Brott T, Broderick J, Kothari R, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke. 1997; 28: 1–5.