Abstract WP332: Characteristics and Outcomes of Patients on Prior Antiplatelet Therapy in the Tranexamic Acid in Primary Intracerebral Haemorrhage-2 (TICH-2) Trial

Abstract

Background: Prior antiplatelet therapy (APT) may be associated with worse outcome in intracerebral haemorrhage (ICH). We explored the effects of APT on clinical outcomes in patients with ICH in the Tranexamic acid in primary IntraCerebral Haemorrhage-2 (TICH-2) trial. Methods: TICH-2 is an ongoing prospective randomised double-blind blinded-endpoint trial testing the safety and efficacy of tranexamic acid in patients with spontaneous ICH presenting within 8 hours of onset. Data from 2255 patients recruited up to July 2017 were analysed blinded to treatment allocation. Clinical outcomes were compared between patients with and without prior APT, with adjustment for age, National Institutes of Health Stroke Scale (NIHSS), premorbid modified Rankin Scale (mRS) and presence of intraventricular haemorrhage. Haematoma expansion was defined as a relative increase in haematoma volume of > 33% or an absolute increase of > 6 mL from baseline. Results: 593 patients (26.3%) had prior APT and these were older (mean age 75.7 vs 66.3 years) and more likely to have ischaemic heart disease (24.8%, 147 vs 2.8%, 46) and prior stroke/transient ischaemic attack (35.8%, 212 vs 6.4%, 106) than those with no APT. The APT group had larger baseline haematoma volume (27.9 mL vs 20.8 mL, table) and were more likely to have intraventricular haemorrhage (40.3% vs 29.1%). The rate of haematoma expansion was not significantly greater in the APT group. At day 90, the APT group had a worse functional outcome, mRS acOR 1.36 (95% CI 1.10-1.66, p=0.004) and higher mortality rate, hazard ratio 2.26 (95% CI 1.88-2.72, p<0.001). Discussion & Conclusion: TICH-2 is the largest trial of a haemostatic agent in ICH to-date. Patients with prior APT had significantly greater baseline haematoma volume, worse functional outcome and higher mortality at day 90. Complete data will be presented in the conference. Therapies targeting enhancement of platelet function should be further researched.