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History of Nonsteroidal Anti-inflammatory Drug Use and Functional Outcomes After Spontaneous Intracerebral Hemorrhage

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Abstract

Background and Purpose

Preclinical and clinical studies have suggested a potential benefit from COX-2 inhibition on secondary injury activation after spontaneous intracerebral hemorrhage (ICH). The aim of this study was to investigate the effect of pre-admission NSAID use on functional recovery in spontaneous ICH patients.

Methods

Consecutive adult ICH patients enrolled in the Intracerebral Hemorrhage Outcomes Project (2009–2018) with available 90-day follow-up data were included. Patients were categorized as NSAID (daily COX inhibitor use ≤ 7 days prior to ICH) and non-NSAID users (no daily COX inhibitor use ≤ 7 days prior to ICH). Primary outcome was the ordinal 90-day modified Rankin Scale (mRS) score. Outcomes were compared between cohorts using multivariable regression and propensity score-matched analyses. A secondary analysis excluding aspirin users was performed.

Results

The NSAID and non-NSAID cohorts comprised 228 and 361 patients, respectively. After 1:1 matching, the matched cohorts each comprised 140 patients. The 90-day mRS were comparable between the NSAID and non-NSAID cohorts in both the unmatched (aOR = 0.914 [0.626–1.336], p = 0.644) and matched (aOR = 0.650 [0.392–1.080], p = 0.097) analyses. The likelihood of recurrent ICH at 90 days was also comparable between the NSAID and non-NSAID cohorts in both the unmatched (aOR = 0.845 [0.359–1.992], p = 0.701) and matched analyses (aOR = 0.732 [0.241–2.220], p = 0.581). In the secondary analysis, the non-aspirin NSAID and non-NSAID cohorts comprised 38 and 361 patients, respectively. After 1:1 matching, the matched cohorts each comprised 38 patients. The 90-day mRS were comparable between the non-aspirin NSAID and non-NSAID cohorts in both the unmatched (aOR = 0.615 [0.343–1.101], p = 0.102) and matched (aOR = 0.525 [0.219–1.254], p = 0.147) analyses. The likelihood of recurrent ICH at 90 days was also comparable between the non-aspirin NSAID and non-NSAID cohorts in both the unmatched (aOR = 2.644 [0.258–27.091], p = 0.413) and matched (aOR = 2.586 [0.228–29.309], p = 0.443) analyses. After the exclusion of patients with DNR or withdrawal of care status, NSAID use was associated with lower mRS at 90 days (aOR = 0.379 [0.212–0.679], p = 0.001), lower mRS at hospital discharge (aOR = 0.505 [0.278–0.919], p = 0.025) and lower 90-day mortality rates (aOR = 0.309 [0.108–0.877], p = 0.027).

Conclusions

History of nonselective COX inhibition may affect functional outcomes in ICH patients. Pre-admission NSAID use did not appear to worsen the severity of presenting ICH or increase the risk of recurrent ICH. Additional clinical studies may be warranted to investigate the effects of pre-admission NSAID use on ICH outcomes.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA

    Natasha Ironside, Ching-Jen Chen, Thomas J. Buell & Edward Sander Connolly

  2. Department of Neurological Surgery, Columbia University Medical Center, 710 W. 168th St., New York, NY, 10032, USA

    Natasha Ironside & Victoria Dreyer

  3. Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA

    Dale Ding

Authors
  1. Natasha Ironside
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  2. Ching-Jen Chen
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  3. Victoria Dreyer
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  4. Dale Ding
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Contributions

Design of the study was done by NI, C-JC, and ESC. Statistical analysis was done by NI and VD. Drafting of manuscript was done by NI. Interpretation of data was done by C-JC, DD, and ESC. Revision of manuscript for important intellectual content was done by C-JC, DD, TJB, and ESC.

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Correspondence to Natasha Ironside.

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Informed consent was obtained for all human participants in the study.

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Ironside, N., Chen, CJ., Dreyer, V. et al. History of Nonsteroidal Anti-inflammatory Drug Use and Functional Outcomes After Spontaneous Intracerebral Hemorrhage. Neurocrit Care 34, 566–580 (2021). https://doi.org/10.1007/s12028-020-01022-1

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  • DOI: https://doi.org/10.1007/s12028-020-01022-1

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