Toyoda K, Okada Y, Minematsu K, Kamouchi M, Fujimoto S, Ibayashi S, Inoue T
Department of Cerebrovascular Disease, Cerebrovascular Center and Clinical Research Institute, National Kyushu Medical Center, 1-8-1 Jigyohama, Fukuoka 810-8563, Japan.
Neurology. 2005 Oct 11;65(7):1000-4. doi: 10.1212/01.wnl.0000179178.37713.69.
The purpose of this study was to examine the effect of antiplatelet therapy on the initial severity and the acute outcome of intracerebral hemorrhage (ICH).
The authors reviewed records of 251 consecutive patients hospitalized in their cerebrovascular center within 24 hours after onset of ICH.
Fifty-seven patients (23%) had development of ICH during oral antiplatelet therapy. The major indication for antiplatelet therapy was the prevention of stroke recurrence (63%). As compared with patients without antiplatelet therapy, those who received antiplatelet therapy more frequently were aged 70 years or older (60% vs 35%; p < 0.001), had previous symptomatic ischemic stroke (54% vs 7%; p < 0.0001), had diabetes mellitus (26% vs 15%; p < 0.05), and had heart disease (32% vs 8%; p < 0.0001). Antiplatelet therapy was predictive of an increase in the hematoma volume by more than 40% on the second hospital day (hematoma enlargement, odds ratio [OR] 7.67, 95% CI 1.62 to 36.4) and the need for emergent surgical evacuation of the hematoma (OR 3.10, 95% CI 1.18 to 8.15). Antiplatelet therapy was an independent predictor for the occurrence of any of hematoma enlargement, emergent death, or evacuation surgery, which suggests that clinical deterioration occurs into the second hospital day (OR 7.45, 95% CI 2.46 to 22.5).
Antiplatelet therapy seems to contribute to the acute clinical deterioration of intracerebral hemorrhage.
本研究旨在探讨抗血小板治疗对脑出血（ICH）初始严重程度及急性结局的影响。
作者回顾了251例在脑出血发病后24小时内入住其脑血管中心的连续患者的病历。
57例患者（23%）在口服抗血小板治疗期间发生脑出血。抗血小板治疗的主要指征是预防卒中复发（63%）。与未接受抗血小板治疗的患者相比，接受抗血小板治疗的患者更常见于70岁及以上（60%对35%；p<0.001），既往有症状性缺血性卒中（54%对7%；p<0.0001），患有糖尿病（26%对15%；p<0.05），以及患有心脏病（32%对8%；p<0.0001）。抗血小板治疗可预测在住院第二天血肿体积增加超过40%（血肿扩大；优势比[OR]7.67,95%置信区间1.62至36.4）以及需要紧急手术清除血肿（OR 3.10,95%置信区间1.18至8.15）。抗血小板治疗是血肿扩大、紧急死亡或清除手术发生的独立预测因素，这表明临床恶化持续至住院第二天（OR 7.45,95%置信区间2.46至22.5）。
抗血小板治疗似乎会导致脑出血的急性临床恶化。
