1. Mortality in patients with intracerebral hemorrhage associated with antiplatelet agents, oral anticoagulants or no antithrombotic therapy.
- Author
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Franco L, Paciaroni M, Enrico ML, Scoditti U, Guideri F, Chiti A, De Vito A, Terruso V, Consoli D, Vanni S, Giossi A, Manina G, Nitti C, Re R, Sacco S, Cappelli R, Beyer-Westendorf J, Pomero F, Agnelli G, and Becattini C
- Subjects
- Cerebral Hemorrhage chemically induced, Cerebral Hemorrhage drug therapy, Fibrinolytic Agents adverse effects, Humans, Prospective Studies, Retrospective Studies, Anticoagulants adverse effects, Platelet Aggregation Inhibitors adverse effects
- Abstract
The association between preceding treatment with antiplatelet agents (APs), vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) and mortality after intracerebral hemorrhage (ICH) remains unclear. The aim of this multicenter, prospective cohort study was to assess the risk for death after ICH in consecutive patients who were on treatment with APs, VKAs, DOACs, or no antithrombotic agent. The primary outcome was in-hospital death by day 30. ICH volume at admission and volume expansion were centrally assessed. Out of 598 study patients, in-hospital death occurred in 21% of patients who were on treatment with APs, 25% with VKAs, 30% with DOACs, and 13% with no antithrombotics. Crude death rate was higher in patients on antithrombotics as compared to patients receiving no antithrombotic agent. At multivariate analysis, age (HR 1.07; 95% CI 1.04-1.10), previous stroke (HR 1.83; 95% CI 1.14-2.93), GCS ≤8 at admission (HR 6.06; 95% CI 3.16-9.74) and GCS 9-12 (HR 3.38; 95% CI 1.81-6.33) were independent predictors of death. Treatment with APs (HR 1.29; 95% CI 0.61-2.76), VKAs (HR 1.42; 95% CI 0.70-2.88) or DOACs (HR 1.28; 95% CI 0.61-2.73) were not predictors of death in the overall study population, in non-trauma associated ICH as well as when GCS was not included in the model. ICH volume and volume expansion were independent predictors of death. In conclusion, preceding treatment with antithrombotic is associated with the severity of ICH. Age, previous stroke and clinical severity at presentation were independent predictors of in-hospital death in patients with ICH., Competing Interests: Disclosure of Conflict of interest Becattini C reports lectures fees from Boehringer Ingelheim and Bayer HealthCare. Beyer-Westendorf J has received honoraria and research support from Bayer HealthCare, Boehringer Ingelheim, Bristol-Myers Squibb, and Pfizer. Agnelli G reports lectures fees from Boehringer Ingelheim, from Sanofi, from Bayer HealthCare, and from Daiichi-Sankyo. The authors report no relationships that could be construed as a conflict of interest., (Copyright © 2019. Published by Elsevier B.V.)
- Published
- 2020
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