Mortality in patients with intracerebral hemorrhage associated with antiplatelet agents,oral anticoagulants or no antithrombotic therapy |
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| Institution: | 1. University of Perugia, Perugia, Italy;2. UOC Neurologia Ravenna - AUSL Romagna, Italy;3. Parma Hospital, Parma, Italy;4. University of Siena, Siena, Italy;5. S. Andrea Hospital, La Spezia, Italy;6. Ferrara Hospital, Ferrara, Italy;7. Ospedale Civico di Palermo, Palermo, Italy;8. Vibo Valentia Hospital, Vibo Valentia, Italy;9. Careggi University Hospital, Firenze, Italy;10. Cremona Hospital, Cremona, Italy;11. Policlinico Hospital, Milano, Italy;12. Ospedali Riuniti di Ancona, Ancona, Italy;13. Ospedale Maggiore della Carità, Novara, Italy;14. Avezzano Hospital, L’ Aquila, Italy;15. University Hospital, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany;p. Santa Croce Hospital, Cuneo, Italy;1. Department of internal medicine B, Hadassah-Hebrew University Medical Center, Jerusalem, Israel;2. Department of Nephrology and hypertension, Hadassah-Hebrew University Medical Center, Jerusalem, Israel;1. Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, Faculty of Medicine, University of Ferrara, Ferrara, Italy;2. Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy;1. School of Pharmacy, University of Namibia, 340 Mandume Ndemufayo Avenue, Private Bag 13301, Windhoek, Namibia;2. The Newcastle upon Tyne Hospitals NHS Foundation Trust, Pharmacy Department, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK;3. School of Medicine, University of Namibia, 340 Mandume Ndemufayo Avenue, Windhoek, Namibia;1. University of Eastern Piedmont, Novara, Italy;2. Campus Bio-Medico Hospital, Rome;3. San Filippo Neri Hospital of Rome, Italy |
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| 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. |
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