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Role of Antiplatelet Agents in Hematoma Expansion During The Acute Period of Intracerebral Hemorrhage

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Abstract

Background

Oral anticoagulants have been associated with greater hematoma expansion in patients with intracerebral hemorrhage (ICH). The purpose of this study was to determine whether the reported use of antiplatelet agents also results in greater hematoma expansion.

Methods

Retrospective review of patients with spontaneous supratentorial ICH diagnosed within 6 h of onset, who underwent follow-up head CT approximately 48 h later. Digital imaging analysis of initial and second CT scans was performed for comparison of hematoma volume changes between patients reporting and those not reporting antecedent antiplatelet use. Statistical analyses to determine predictors of ICH volume change and in-hospital mortality were also performed via multivariate regression models.

Results

Of the 70 patients included, 17 were documented as taking antiplatelet agents. Groups were comparable regarding baseline demographic, clinical and laboratory characteristics, and the timing of CT scans was similar. Patients reporting antiplatelet use experienced greater absolute increase (7.7 ml vs. 5.5 ml) and proportional increase (110% vs. 21%) in ICH volume than those not reporting antiplatelet use, but these differences were not statistically significant (P = 0.94 and 0.61 respectively; Wilcoxon test). Baseline hematoma volume tended to correlate with percentage volume increase (P < 0.1), whereas IVH was inversely associated with percent volume increase (P < 0.05). Age (P < 0.05), absolute volume increase (P < 0.005), and final volume (P < 0.001) were associated with in-hospital mortality, the rates of which were similar between the two study groups (18% vs. 17%).

Conclusions

Patients reporting antiplatelet use experienced similar degrees of hematoma expansion compared to patients not reporting antiplatelet use.

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Authors and Affiliations

  1. Division of Cerebrovascular and Critical Care Neurology, Thomas Jefferson Medical Center, 900 Walnut Street, Suite 200, Philadelphia, PA, 19107, USA

    Michael Moussouttas

  2. Neurocritical Care Division, Columbia University Medical Center, New York, NY, USA

    Rishi Malhotra & Luis Fernandez

  3. Department of Neurosurgery, Thomas Jefferson Medical Center, Philadelphia, PA, USA

    Mitchell Maltenfort

  4. Columbia Presbyterian Hospital, New York, NY, USA

    Melissa Holowecki, Jennifer Delgado & Nadine Lawson

  5. Division of Neurocritical Care, Columbia University Medical Center, New York, NY, USA

    Neeraj Badjatia

Authors
  1. Michael Moussouttas
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  2. Rishi Malhotra
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  3. Luis Fernandez
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  4. Mitchell Maltenfort
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  5. Melissa Holowecki
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  6. Jennifer Delgado
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  7. Nadine Lawson
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  8. Neeraj Badjatia
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Correspondence to Michael Moussouttas.

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Moussouttas, M., Malhotra, R., Fernandez, L. et al. Role of Antiplatelet Agents in Hematoma Expansion During The Acute Period of Intracerebral Hemorrhage. Neurocrit Care 12, 24–29 (2010). https://doi.org/10.1007/s12028-009-9290-0

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  • DOI: https://doi.org/10.1007/s12028-009-9290-0

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