Prior Antiplatelet Therapy, Excluding Phosphodiesterase Inhibitor Is Associated with Poor Outcome in Patients with Spontaneous Intracerebral Haemorrhage

  • Zhuo-Hao Liu
  • Chi-Hung Liu
  • Po-Hsun Tu
  • Ping K. Yip
  • Ching-Chang Chen
  • Yu-Chi Wang
  • Nan-Yu Chen
  • Yu-Sheng LinEmail author
Original Article


There is conflicting results on whether prior antiplatelet therapy (APT) is associated with poor outcome in spontaneous intracerebral haemorrhage (ICH) patients. To determine whether prior APT is associated with spontaneous ICH, and whether there is a difference between the different types of APT, including cyclooxygenase inhibitor (COX-I), adenosine diphosphate receptor inhibitor (ADP-I) and phosphodiesterase inhibitor (PDE-I). A retrospective study of patients with ICH diagnosed between 2001 and 2013 in the National Health Insurance Research Database. Baseline unbalance between APT and non-APT groups was solved by multivariable adjustment (primary analysis) and propensity score matching (sensitivity analysis). Patients with prior APT had a higher rate of in-hospital death (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.09–1.23) compared to non-APT group. Compared to non-APT group, there was a greater rate of in-hospital death with spontaneous ICH with ADP-I (OR, 1.49; 95% CI, 1.24–1.79) and COX-I (OR, 1.17; 95% CI, 1.09–1.25). PDE-I exhibited no difference in in-hospital death with spontaneous ICH (OR, 1.03; 95% CI, 0.91–1.16) compared to non-APT group. Remarkably, the in-hospital mortality rate was significantly higher in the ADP-I group than in the PDE-I group (hazard ratio, 1.45; 95% CI, 1.17–1.80). In this study, ADP-I and COX-1, but not PDE-I, are the most likely contributors to the association of APT with poor outcome with spontaneous ICH patients. These findings suggest that the complexity of the different mechanism of actions of prior APT can alter the outcome in spontaneous ICH.


Intracerebral haemorrhage Antiplatelet treatment In-hospital mortality Outcome 



The authors thank for Alfred Hsing-Fen Lin and Zoe Ya-Jhu Syu for their statistical assistance.


PSM propensity score matching

APT,anti-platelet therapy

ICH intracerebral haemorrhage

ADP-I adenosine diphosphate receptor inhibitor

COX-I irreversible cyclooxygenase inhibitor

PDE-I phosphodiesterase inhibitor

Funding Information

This work was supported by the Chang Gung Memorial Hospital (CMRPG3H1061, CMRPG3G1002) grant number.

Compliance with Ethical Standards

This study was exempt from approval requirements by the Institutional Review Board of Chang Gung Memorial Hospital in Taiwan (IRB number, 201601518B0) and without permission of patient’s consent, given that it was an epidemiology study with no definable patient information.

Conflict of Interest

The authors declare that they have no conflict of interests.

Supplementary material

12975_2019_722_MOESM1_ESM.docx (51 kb)
ESM 1 (DOCX 50 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Chang Gung Memorial Hospital at LinkouChang Gung Medical College and UniversityTaoyuan CityTaiwan
  2. 2.Department of Neurology, Chang Gung Memorial Hospital at LinkouChang Gung Medical College and UniversityTaoyuan CityTaiwan
  3. 3.Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Blizard InstituteLondonUK
  4. 4.Department of Internal Medicine, Chang Gung Memorial Hospital at LinkouChang Gung Medical College and UniversityTaoyuan CityTaiwan
  5. 5.Department of Internal Medicine, Division of Cardiology at ChiayiChang Gung Memorial Hospital, Chang Gung Medical College and UniversityPu-TZ CityTaiwan

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