Abstract
Background
Craniotomy is potentially life-saving in selected patients with intracerebral hemorrhage (ICH). Aside from specific scenarios (cerebellar hemorrhage with hydrocephalus, midline shift from an accessible lesion, etc.) the indications for surgical decompression are controversial. Based on the earlier work that aspirin and reduced platelet activity are associated with larger hemorrhage size and hemorrhage growth, we tested the hypothesis that aspirin or reduced platelet activity would be associated with increased odds of craniotomy, likely through hemorrhage growth.
Methods
We prospectively identified patients with spontaneous ICH and routinely measured platelet activity on admission. Patients were prospectively tracked, and outcomes were obtained with the modified Rankin Scale (mRS).
Results
There were 187 patients in the sample. Craniotomy (N = 32, 17%) was associated with a higher initial ICH volume (37.9 [20–63] vs. 12 [5–24] ml, P < 0.001) and location (P = 0.005). In multivariate logistic regression, after controlling for ICH volume and location, any known aspirin use (OR 3.4, 95% CI 1.1–10.4, P = 0.03), platelet activity ≤550 aspirin reaction units (OR 3.1, 95% CI 1.05–9.3, P = 0.04), or an elevated PFA-EPI closure time (OR 3.2, 95% CI 1.02–10.3, P = 0.04) were associated with increased odds of craniotomy. Craniotomy was not associated with mRS at 14 days, 28 days, or 3 months.
Conclusions
After correction for ICH volume and location, aspirin use or reduced platelet activity was associated with similar increased odds for craniotomy.
Similar content being viewed by others
References
Pantazis G, Tsitsopoulos P, Mihas C, Katsiva V, Stavrianos V, Zymaris S. Early surgical treatment vs conservative management for spontaneous supratentorial intracerebral hematomas: a prospective randomized study. Surg Neurol. 2006;66:492–501.
Rabinstein AA, Atkinson JL, Wijdicks EFM. Emergency craniotomy in patients worsening due to expanded cerebral hematoma. Neurology. 2002;58:1367–72.
Cho D-Y, Chen C-C, Lee W-Y, Lee H-C, Ho L-H. A new modified intracerebral hemorrhage score for treatment decisions in basal ganglia hemorrhage—a randomized trial. Crit Care Med. 2008;36:2151–6.
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.
Naidech AM, Jovanovic B, Liebling S, Garg RK, Bassin SL, Bendok BR, Bernstein RA, Alberts MJ, Batjer HH. Reduced platelet activity is associated with early clot growth and worse 3 month outcome after intracerebral hemorrhage. Stroke. 2009;40:2398–401.
The joint commission. Available at http://www.jointcommission.org/npsg_reconciling_medication/. Accessed on April 25, 2011.
Verifynow aspirin package insert.
Kothari R, Brott T, Broderick J, Barsan W, Sauerbeck L, Zuccarello M, Khoury J. The abcs of measuring intracerebral hemorrhage volumes. Stroke. 1996;27:1304–5.
Banks JL, Marotta CA. Outcomes validity and reliability of the modified rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke. 2007;38:1091–6.
Wilson JTL, Hareendran A, Grant M, Baird T, Schulz UGR, Muir KW, Bone I. Improving the assess of outcomes in stroke. Use of a structured interview to assign grade on the modified rankin scale. Stroke. 2002;33:2243–6.
Sansing LH, Messe SR, Cucchiara BL, Cohen SN, Lyden PD, Kasner SE. Prior antiplatelet use does not affect hemorrhage growth or outcome after ich. Neurology. 2009;72:1397–402.
Thompson BB, Bejot Y, Caso V, Castillo J, Christensen H, Flaherty ML, Foerch C, Ghandehari K, Giroud M, Greenberg SM, Hallevi H, Hemphill JC III, Heuschmann P, Juvela S, Kimura K, Myint PK, Nagakane Y, Naritomi H, Passero S, Rodriguez-Yanez MR, Roquer J, Rosand J, Rost NS, Saloheimo P, Salomaa V, Sivenius J, Sorimachi T, Togha M, Toyoda K, Turaj W, Vemmos KN, Wolfe CD, Woo D, Smith EE. Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review. Neurology. 2010;75:1333–42.
Mayer SA, Brun NC, Broderick J, Davis S, Diringer MN, Skolnick BE, Steiner T. Efficacy and safety of recombinant activated factor vii for acute intracerebral hemorrhage. New Engl J Med. 2008;358:2127–37.
Sutherland CS, Hill MD, Kaufmann AM, Silvaggio JA, Demchuk AM, Sutherland GR. Recombinant factor viia plus surgery for intracerebral hemorrhage. Can J Neurol Sci. 2008;35:567–72.
Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, Karimi A, Shaw MD, Barer DH. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the international surgical trial in intracerebral haemorrhage (stich): a randomised trial. Lancet. 2005;365:387–97.
Prasad K, Mendelow DA, Gregson B. Surgery for primary supratentorial intracerebral haemorrhage. Cochrane Database of Systematic Reviews. 2008; CD000200.
Morgan T, Zuccarello M, Narayan R, Keyl P, Lane K, Hanley D. Preliminary findings of the minimally-invasive surgery plus rtpa for intracerebral hemorrhage evacuation (mistie) clinical trial. Acta Neurochir Suppl. 2008;105:147–51.
Acknowledgments
All those who meaningfully contributed are listed as an author. This work was departmentally funded. AMN has received research funding from the Northwestern Memorial Foundation and Gaymar, Inc. for unrelated work, and serves as a monitor for two unrelated NIH-funded clinical studies.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Naidech, A.M., Rosenberg, N.F., Bernstein, R.A. et al. Aspirin Use or Reduced Platelet Activity Predicts Craniotomy After Intracerebral Hemorrhage. Neurocrit Care 15, 442–446 (2011). https://doi.org/10.1007/s12028-011-9557-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12028-011-9557-0