Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China.
Thromb Haemost. 2012 Feb;107(2):241-7. doi: 10.1160/TH11-06-0439. Epub 2011 Dec 21.
Intracranial haemorrhage (ICH) accounts for ~35% of all strokes in Chinese. Anti-platelet agent is often avoided after an index event due to the possibility of recurrent ICH. This single-centered observational study included 440 consecutive Chinese patients with a first spontaneous ICH surviving the first month performed during 1996-2010. The subjects were identified, and their clinical characteristics, anti-platelet therapy after ICH, and outcomes including recurrent ICH, ischaemic stroke, and acute coronary syndrome were checked from hospital records. Of these 440 patients, 56 patients (12.7%) were prescribed aspirin (312 patient-aspirin years). After a follow-up of 62.2 ± 1.8 months, 47 patients had recurrent ICH (10.7%, 20.6 per 1,000 patient years). Patients prescribed aspirin did not have a higher risk of recurrent ICH compared with those not prescribed aspirin (22.7 per 1,000 patient-aspirin years vs. 22.4 per 1,000 patient years, p=0.70). Multivariate analysis identified age > 60 years (hazard ratio [HR]: 2.0, 95% confidence interval [CI]: 1.07-3.85, p=0.03) and hypertension (HR: 2.0, 95% CI: 1.06-3.75, p=0.03) as independent predictors for recurrent ICH. In a subgroup analysis including 127 patients with standard indications for aspirin of whom 56 were prescribed aspirin, the incidence of combined vascular events including recurrent ICH, ischaemic stroke, and acute coronary syndrome was statistically lower in patients prescribed aspirin than those not prescribed aspirin (52.4 per 1,000 patient-aspirin years, vs. 112.8 per 1,000 patient-years, p=0.04). In conclusion, we observed in a cohort of Chinese post-ICH patients that aspirin use was not associated with an increased risk for a recurrent ICH.
颅内出血 (ICH) 约占中国所有中风的 35%。由于可能再次发生 ICH,索引事件后常避免使用抗血小板药物。这项单中心观察性研究纳入了 1996 年至 2010 年间首次发生自发性 ICH 且存活至第一个月的 440 例连续中国患者。从医院记录中确定了患者的临床特征、ICH 后抗血小板治疗以及包括再发性 ICH、缺血性中风和急性冠脉综合征在内的结局。在这 440 例患者中,56 例(12.7%)接受了阿司匹林治疗(312 例患者-阿司匹林年)。随访 62.2±1.8 个月后,47 例患者发生再发性 ICH(10.7%,1000 患者年 20.6 例)。与未接受阿司匹林治疗的患者相比,接受阿司匹林治疗的患者再发性 ICH 的风险没有更高(每 1000 患者-阿司匹林年 22.7 例 vs. 每 1000 患者年 22.4 例,p=0.70)。多变量分析确定年龄 >60 岁(危险比[HR]:2.0,95%置信区间[CI]:1.07-3.85,p=0.03)和高血压(HR:2.0,95%CI:1.06-3.75,p=0.03)是再发性 ICH 的独立预测因素。在包括 127 例有阿司匹林标准适应证的患者亚组分析中,其中 56 例接受了阿司匹林治疗,与未接受阿司匹林治疗的患者相比,接受阿司匹林治疗的患者包括再发性 ICH、缺血性中风和急性冠脉综合征在内的联合血管事件发生率较低(每 1000 患者-阿司匹林年 52.4 例,每 1000 患者年 112.8 例,p=0.04)。总之,我们在中国 post-ICH 患者队列中观察到,阿司匹林的使用与再发性 ICH 风险增加无关。