Abstract
Background: Antithrombotic therapy influences clinical outcome after spontaneous intracerebral hemorrhage (ICH). However, evidence on the effect of different antithrombotic therapies on outcome and a comparison between different therapies is scarce, while this is important for medical decision making. Therefore, we investigated clinical outcome after ICH stratified by type of antithrombotic therapy.Patients/Methods: We performed a cohort study selecting consecutive ICH patients from our database, excluding patients without data on medication or therapeutic heparin use. Primary outcome was poor outcome (modified Rankin Scale ≥ 4) after 90 days. Secondary outcome was mortality at 90 days. We analyzed outcome and survival in patients with ICH using vitamin K antagonists (VKA), antiplatelet therapy (AP), and direct oral anticoagulant (DOAC) compared to no antithrombotic therapy adjusted for age, National Institutes of Health Stroke Scale (NIHSS), infratentorial localization, intraventricular extension, history of hypertension, diabetes, or stroke, and interaction between age and NIHSS.Results: We included 916 patients (223 AP, 161 VKA, and 40 DOAC). VKA (adjusted odds ratio [aOR] 3.2, 95% confidence interval [CI], 1.6–6.3) and AP (aOR = 2.0, 95%CI: 1.1–3.7) were associated with poor outcome. DOAC use did not reach statistical significance (aOR = 2.4, 95%CI: 0.8–7.7). Patients who used any antithrombotic therapy had poorer survival compared to patients without antithrombotic treatment and patients using AP and DOAC had better survival compared to VKA after adjustment.Conclusions: Patients with antithrombotic therapy have worse clinical outcome after ICH. Patients using VKA have higher risk of poor outcome and mortality compared to patients using AP. These findings highlight the deleterious effect of antithrombotic therapy in patients with ICH and stress the need for effective therapies for ICH patients.
Highlights
Stroke is one of the leading causes of death and disability in the world
For vitamin K antagonists (VKA), an association with poor outcome and mortality has been shown [5], for antiplatelet therapy (AP) there are conflicting results in the literature weather its use is associated with poor outcome after intracerebral hemorrhage (ICH) [6, 7]
When only comparing patients with different antithrombotic therapies (AP, VKA, or direct oral anticoagulant (DOAC)) there were no statistically significant differences in baseline characteristics, except that patients with AP more often had a history of diabetes or stroke
Summary
Stroke is one of the leading causes of death and disability in the world. the majority of patients present with ischemic stroke, functional outcome and burden on society of patients with hemorrhagic stroke is worse [1]. Most studies reporting on outcome after ICH report on short term mortality [8, 9] and have not compared ICH patients with different types of antithrombotic treatment [10]. More data on clinical functioning of patients with ICH and comparison of patients with different antithrombotic therapies could help guide clinicians in their decision making for this patient group. We investigated clinical functioning of patients at 90 days after ICH in relation to concomitant antithrombotic therapy. Antithrombotic therapy influences clinical outcome after spontaneous intracerebral hemorrhage (ICH). We analyzed outcome and survival in patients with ICH using vitamin K antagonists (VKA), antiplatelet therapy (AP), and direct oral anticoagulant (DOAC) compared to no antithrombotic therapy adjusted for age, National Institutes of Health Stroke Scale (NIHSS), infratentorial localization, intraventricular extension, history of hypertension, diabetes, or stroke, and interaction between age and NIHSS
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