Skip to main content
SpringerLink
Log in

Reduced Platelet Activity is More Common than Reported Anti-Platelet Medication Use in Patients with Intracerebral Hemorrhage

  • Original Article
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

Anti-platelet medication and reduced platelet activity are associated with an increased risk of death after intracerebral hemorrhage (ICH). The optimal assay for assessing platelet activity is not defined. We hypothesized that reduced platelet activity would be common after ICH.

Patients and Methods

We prospectively enrolled 72 consecutive patients with ICH and routinely measured platelet activity with both the PFA-100 (Siemens AG, Germany) and the VerifyNow-ASA (Accumetrics, CA, USA) systems on admission. We prospectively recorded anti-platelet medication use prior to ICH.

Results

VerifyNow-ASA measurements were associated with aspirin (P = 0.001) and clopidogrel (P = 0.01) use prior to ICH. Combined clopidogrel and aspirin therapy was more potent than either alone. Of 33 patients with reduced platelet activity on the VerifyNow-ASA assay, 14 (42%) were not known to take anti-platelet agents. Of 27 patients with reduced platelet activity on the PFA-100, a related but different 14 (52%) were not known to take anti-platelet agents. There was a poor agreement between the assays (κ = 0.26, P = 0.07) on which patients had reduced platelet activity among the patients not known to take aspirin.

Conclusions

A medication history does not reliably identify patients with reduced platelet activity after ICH, and this may explain studies that found no association between known aspirin use and outcomes. Future studies should screen for unknown use of anti-platelet medications after ICH. Neither assay perfectly identified patients who reportedly used anti-platelet medication before ICH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Broderick JP, Diringer MN, Hill MD, Brun NC, Mayer SA, Steiner T, et al. Recombinant activated factor vii intracerebral hemorrhage trial investigators. Determinants of intracerebral hemorrhage growth—an exploratory analysis. Stroke. 2007;38:1072–5. doi:10.1161/01.STR.0000258078.35316.30.

    Article  CAS  PubMed  Google Scholar 

  2. Flibotte J, Hagan N, O’Donnell J, Greenberg S, Rosand J. Warfarin, hematoma expansion, and outcome of intracerebral hemorrhage. Neurology. 2004;63:1059–64.

    CAS  PubMed  Google Scholar 

  3. Saloheimo P, Ahonen M, Juvela S, Pyhtinen J, Savolainen E, Hillborm M. Regular aspirin use preceding the onset of primary intracerebral hemorrhage is an independent predictor for death. Stroke. 2006;37:129–33. doi:10.1161/01.STR.0000196991.03618.31.

    Article  CAS  PubMed  Google Scholar 

  4. Roquer J, Rodriguez-Compello A, Gomis M, Ois A, Munteis E. Previous anti-platelet therapy is an independent predictor of 30-day mortality after spontaneous supratentorial intracerebral hemorrhage. J Neurol. 2005;252:412–6. doi:10.1007/s00415-005-0659-5.

    Article  CAS  PubMed  Google Scholar 

  5. Foerch C, Sitzer M, Steinmetz H, Neumann-Haefelin T. Pretreatment with anti-platelet agents is not independently associated with unfavorable outcome in intracerebral hemorrhage. Stroke. 2006;37:2165–7. doi:10.1161/01.STR.0000231842.32153.74.

    Article  CAS  PubMed  Google Scholar 

  6. Sansing LH, Messe SR, Cucchiara BL, Cohen SN, Lyden PD, Kasner SE. Chant investigators. Prior antiplatelet use does not affect hemorrhage growth or outcome after ich. Neurology. 2009; Jan 9 [Epub ahead of print]. doi 10.1212/01.wnl.0000342709.31341.88.

  7. Lordkipanidze M, Pharand C, Schampaert E, Turgeon J, Palisaitis D, Diodati J. A comparison of six major platelet function tests to determine the prevalence of aspirin resistance in patients with stable coronary artery disease. Eur Heart J. 2007;28:1702–8. doi:10.1093/eurheartj/ehm226.

    Article  CAS  PubMed  Google Scholar 

  8. Naidech A, Bernstein R, Levasseur K, Bassin S, Bendok B, Batjer H, et al. Platelet activity and outcome after intracerebral hemorrhage. Ann Neurol. 2009;65:352–6. doi:10.1002/ana.21618.

    Article  PubMed  Google Scholar 

  9. Kundu S, Heilmann E, Sio R, Garcia C, Davidson R, Ostgaard R. Description of an in vitro platelet function analyzer—pfa-100. Semin Thromb Hemost. 1885;21:106–12.

    Google Scholar 

  10. Dichiara J, Bliden K, Tantry U, Chaganti S, Kreutz R, Gesheff T, et al. Platelet function measured by Verifynow identifies generalized high platelet reactivity in aspirin treated patients. Platelets. 2007;18:414–23. doi:10.1080/09537100701206824.

    Article  CAS  PubMed  Google Scholar 

  11. The joint commission. Using medication reconciliation to prevent errors. 2008. http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_35.htm. Accessed on 16 June 2008.

  12. Serebruany V, Malinin A, Oshrine B, Sane D, Takserman A, Atar D, et al. Lack of uniform platelet activation in patients after ischemic stroke and choice of anti-platelet therapy. Thromb Res. 2004;113:197–204. doi:10.1016/j.thromres.2004.03.002.

    Article  CAS  PubMed  Google Scholar 

  13. Diener H, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (match): Randomised, double-blind, placebo-controlled trial. Lancet. 2004;8431:331–7. doi:10.1016/S0140-6736(04)16721-4.

    Article  Google Scholar 

  14. Karon BS, Wockenfus A, Scott R, Hartman SJ, McConnell JP, Santrach PJ, et al. Aspirin responsiveness in healthy volunteers measures with multiple assay platforms. Clin Chem. 2008;54:1060–5. doi:10.1373/clinchem.2007.101014.

    Article  CAS  PubMed  Google Scholar 

  15. Lordkipanidze M, Pharand C, Schampaert E, Turgeon J, Palisaitis D, Diodati J. A comparison of six major platelet function tests to determine the prevalence of aspirin resistance in patients with stable coronary artery disease. Eur Heart J. 2007;28:1702–8. doi:10.1093/eurheartj/ehm226.

    Article  CAS  PubMed  Google Scholar 

  16. Johnsen S, Pedersen L, Friis S, Blot W, McLaughlin J, Olsen J, et al. Nonaspirin nonsteroidal anti-inflammatory drugs and risk of hospitalization for intracerebral hemorrhage: A population-based case-control study. Stroke. 2003;34:387–91. doi:10.1161/01.STR.0000054057.11892.5B.

    Article  CAS  PubMed  Google Scholar 

  17. McEvoy G. American society of health system pharmacists. Afhs drug information. http://online.statref.com.ezproxy.galter.northwestern.edu/document.aspx?fxid=1&docid=531. Accessed on January 11.

  18. Coleman JL, Alberts MJ. Effect of aspirin dose, preparation, and withdrawal on platelet response in normal volunteers. Am J Cardiol.. 2006;98:838–41. doi:10.1016/j.amjcard.2006.03.071.

    Article  CAS  PubMed  Google Scholar 

  19. Hillbom ME, Huhtakangas JT. Platelet transfusion in acute intracerebral hemorrhage. Clinicaltrials.Gov number nct00699621. 2008. http://www.clinicaltrials.gov/ct2/show/NCT00699621. Accessed on 25 July 2008.

  20. Reeves MJ, Smith E, Fonarow G, Hernandez A, Pan W, Schwamm LH. Off-hour admission and in-hospital stroke case fatality in the get with the guidelines-stroke program. Stroke. 2009;40:569–76. doi:10.1161/STROKEAHA.108.519355.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was departmentally funded. AMN acknowledges past research support from NovoNordisk, the Neurocritical Care Society, and the Northwestern Memorial Foundation for an unrelated project. AMN acknowledges speaker fees from EKR Therapeutics and research support from Astellas Pharma US and Gaymar Inc. unrelated to this work. MJA has received consulting fees from Accumetrics. Northwestern University owns a use patent in DDAVP for ICH. The financial value of this, if any, is not known.

Author information

Authors and Affiliations

  1. Department of Neurology, Northwestern University, 710 N Lake Shore Drive, 11th Floor, Chicago, IL, 60611, USA

    Andrew M. Naidech, Sarice L. Bassin, Richard A. Bernstein, H. Hunt Batjer, Mark J. Alberts & Thomas P. Bleck

  2. Department of Pathology, Northwestern University, 710 N Lake Shore Drive, 11th Floor, Chicago, IL, 60611, USA

    Paul F. Lindholm

Authors
  1. Andrew M. Naidech
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarice L. Bassin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard A. Bernstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Hunt Batjer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mark J. Alberts
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paul F. Lindholm
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thomas P. Bleck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew M. Naidech.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Naidech, A.M., Bassin, S.L., Bernstein, R.A. et al. Reduced Platelet Activity is More Common than Reported Anti-Platelet Medication Use in Patients with Intracerebral Hemorrhage. Neurocrit Care 11, 307–310 (2009). https://doi.org/10.1007/s12028-009-9219-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-009-9219-7

Keywords

Search

Navigation