Prehemorrhage antiplatelet use in aneurysmal subarachnoid hemorrhage and impact on clinical outcome.

Martina Sebök,Dagmar Verbaan,Luca Regli,Isabel C Hostettler,Maud A Tjerkstra,Menno R Germans,Ali Sardeha,René Post,Ilari M Rautalin,Bert A Coert,Emanuela Keller,William P Vandertop

doi:10.1177/17474930211035647

Abstract

BackgroundLiterature is inconclusive regarding the association between antiplatelet agents use and outcome after aneurysmal subarachnoid hemorrhage.AimsTo investigate the association between clinical outcome and prehemorrhage use in aneurysmal subarachnoid hemorrhage patients as well as the impact of thrombocyte transfusion on rebleed and clinical outcome.MethodsData were collected from prospective databases of two European tertiary reference centers for aneurysmal subarachnoid hemorrhage patients. Patients were divided into “antiplatelet-user” and “non-user” according to the use of acetylsalicylic acid prior to the hemorrhage. Primary outcome was poor clinical outcome at six months (Glasgow Outcome Scale score 1–3). Secondary outcomes were in-hospital mortality and impact of thrombocyte transfusion.ResultsOf the 1033 patients, 161 (15.6%) were antiplatelet users. The antiplatelet users were older with higher incidence of cardiovascular risk factors. Antiplatelet use was associated with poor outcome and in-hospital mortality. After correction for age, sex, World Federation of Neurosurgical Societies score, infarction and heart disorder, pre-hemorrhage acetylsalicylic acid use was only associated with poor clinical outcome at six months (adjusted OR 1.80, 95% CI 1.08–3.02). Thrombocyte transfusion was not associated with a reduction in rebleed or poor clinical outcome.ConclusionIn this multicenter study, the prehemorrhage acetylsalicylic acid use in aneurysmal subarachnoid hemorrhage patients was independently associated with poor clinical outcome at six months. Thrombocyte transfusion was not associated with the rebleed rate or poor clinical outcome at six months.

Highlights

IntroductionAneurysmal subarachnoid hemorrhage (aSAH) is a potentially fatal disease, carrying a six months’ case fatality rate of 55–60%1–3 and more than one third of survivors have severe disability.[4] Many complications such as rebleed, delayed cerebral ischemia (DCI) and hydrocephalus are multifactorial and negatively affect clinical outcome.[3]
Aneurysmal subarachnoid hemorrhage is a potentially fatal disease, carrying a six months’ case fatality rate of 55–60%1–3 and more than one third of survivors have severe disability.[4]
In this multicenter study, the prehemorrhage acetylsalicylic acid use in aneurysmal subarachnoid hemorrhage patients was independently associated with poor clinical outcome at six months

Summary

Introduction

Aneurysmal subarachnoid hemorrhage (aSAH) is a potentially fatal disease, carrying a six months’ case fatality rate of 55–60%1–3 and more than one third of survivors have severe disability.[4] Many complications such as rebleed, delayed cerebral ischemia (DCI) and hydrocephalus are multifactorial and negatively affect clinical outcome.[3]. By a protective effect against chronic inflammation and subsequent aneurysm wall degeneration.[8,9,10] antiplatelet use has been related to early rebleeds, treatment-related complications and worse outcome after aSAH.[11,12,13]. Literature is inconclusive regarding the association between antiplatelet agents use and outcome after aneurysmal subarachnoid hemorrhage

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Conclusion