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Outcomes in Antiplatelet-Associated Intracerebral Hemorrhage in the TICH-2 Randomized Controlled Trial
- Source :
- Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Law, Z K, Desborough, M, Roberts, I, Salman, R A S, England, T J, Werring, D J, Robinson, T, Krishnan, K, Dineen, R, Laska, A C, Peters, N, Egea-Guerrero, J J, Karlinski, M, Christensen, H, Roffe, C, Bereczki, D, Ozturk, S, Thanabalan, J, Collins, R, Beridze, M, Bath, P M & Sprigg, N 2021, ' Outcomes in antiplatelet-associated intracerebral hemorrhage in the tich-2 randomized controlled trial ', Journal of the American Heart Association, vol. 10, no. 5, e019130, pp. 1-12 . https://doi.org/10.1161/JAHA.120.019130, Law, Z K, Desborough, M, Roberts, I, Al-shahi Salman, R, England, T J, Werring, D J, Robinson, T, Krishnan, K, Dineen, R, Laska, A C, Peters, N, Egea-guerrero, J J, Karlinski, M, Christensen, H, Roffe, C, Bereczki, D, Ozturk, S, Thanabalan, J, Collins, R, Beridze, M, Bath, P M & Sprigg, N 2021, ' Outcomes in Antiplatelet-Associated Intracerebral Hemorrhage in the TICH-2 Randomized Controlled Trial ', Journal of the American Heart Association Cardiovascular and Cerebrovascular Disease . https://doi.org/10.1161/JAHA.120.019130
- Publication Year :
- 2021
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2021.
-
Abstract
- Background Antiplatelet therapy increases the risk of hematoma expansion in intracerebral hemorrhage (ICH) while the effect on functional outcome is uncertain. Methods and Results This is an exploratory analysis of the TICH‐2 (Tranexamic Acid in Intracerebral Hemorrhage‐2) double‐blind, randomized, placebo‐controlled trial, which studied the efficacy of tranexamic acid in patients with spontaneous ICH within 8 hours of onset. Multivariable logistic regression and ordinal regression were performed to explore the relationship between pre‐ICH antiplatelet therapy, and 24‐hour hematoma expansion and day 90 modified Rankin Scale score, as well as the effect of tranexamic acid. Of 2325 patients, 611 (26.3%) had pre‐ICH antiplatelet therapy. They were older (mean age, 75.7 versus 66.5 years), more likely to have ischemic heart disease (25.4% versus 2.7%), ischemic stroke (36.2% versus 6.3%), intraventricular hemorrhage (40.2% versus 27.5%), and larger baseline hematoma volume (mean, 28.1 versus 22.6 mL) than the no‐antiplatelet group. Pre‐ICH antiplatelet therapy was associated with a significantly increased risk of hematoma expansion (adjusted odds ratio [OR], 1.28; 95% CI, 1.01–1.63), a shift toward unfavorable outcome in modified Rankin Scale (adjusted common OR, 1.58; 95% CI, 1.32–1.91) and a higher risk of death at day 90 (adjusted OR, 1.63; 95% CI, 1.25–2.11). Tranexamic acid reduced the risk of hematoma expansion in the overall patients with ICH (adjusted OR, 0.76; 95% CI, 0.62–0.93) and antiplatelet subgroup (adjusted OR, 0.61; 95% CI, 0.41–0.91) with no significant interaction between pre‐ICH antiplatelet therapy and tranexamic acid (P interaction=0.248). Conclusions Antiplatelet therapy is independently associated with hematoma expansion and unfavorable functional outcome. Tranexamic acid reduced hematoma expansion regardless of prior antiplatelet therapy use. Registration URL: https://www.isrctn.com ; Unique identifier: ISRCTN93732214.
- Subjects :
- Male
Platelets
antiplatelet
Logistic regression
tranexamic acid
law.invention
Hematoma
Double-Blind Method
hematoma expansion
Randomized controlled trial
Modified Rankin Scale
law
health services administration
Clinical Studies
medicine
Humans
Prospective Studies
cardiovascular diseases
Aged
Cerebral Hemorrhage
Original Research
Intracranial Hemorrhage
Intracerebral hemorrhage
cerebral hemorrhage
Dose-Response Relationship, Drug
business.industry
Odds ratio
Prognosis
medicine.disease
Antifibrinolytic Agents
Stroke
Treatment
Intraventricular hemorrhage
Anesthesia
randomized controlled trial
Disease Progression
Cerebrovascular Disease/Stroke
Female
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
Tranexamic acid
Follow-Up Studies
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 20479980
- Database :
- OpenAIRE
- Journal :
- Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Law, Z K, Desborough, M, Roberts, I, Salman, R A S, England, T J, Werring, D J, Robinson, T, Krishnan, K, Dineen, R, Laska, A C, Peters, N, Egea-Guerrero, J J, Karlinski, M, Christensen, H, Roffe, C, Bereczki, D, Ozturk, S, Thanabalan, J, Collins, R, Beridze, M, Bath, P M & Sprigg, N 2021, ' Outcomes in antiplatelet-associated intracerebral hemorrhage in the tich-2 randomized controlled trial ', Journal of the American Heart Association, vol. 10, no. 5, e019130, pp. 1-12 . https://doi.org/10.1161/JAHA.120.019130, Law, Z K, Desborough, M, Roberts, I, Al-shahi Salman, R, England, T J, Werring, D J, Robinson, T, Krishnan, K, Dineen, R, Laska, A C, Peters, N, Egea-guerrero, J J, Karlinski, M, Christensen, H, Roffe, C, Bereczki, D, Ozturk, S, Thanabalan, J, Collins, R, Beridze, M, Bath, P M & Sprigg, N 2021, ' Outcomes in Antiplatelet-Associated Intracerebral Hemorrhage in the TICH-2 Randomized Controlled Trial ', Journal of the American Heart Association Cardiovascular and Cerebrovascular Disease . https://doi.org/10.1161/JAHA.120.019130
- Accession number :
- edsair.doi.dedup.....e9e506176f0e04ac5e237f9e0e142f2d