Antiplatelet therapies are associated with hematoma enlargement and increased mortality in intracranial hemorrhage.

OBJECTIVE

Antiplatelet therapy (AT) is increasingly used for treating or preventing vascular diseases, especially as a consequence of population aging. However, the risks may sometimes outweigh the benefits, mostly in relation to intracranial hemorrhage (ICH). Our aim was to determine whether AT is associated with hematoma enlargement and increased mortality in ICH.

DESIGN

A prospective, observational cohort study.

SETTING

The Intensive Care Unit (ICU) of Arrixaca University Hospital (Murcia, Spain).

PATIENTS

We studied 156 patients admitted with non-traumatic ICH between January 2006 and August 2008.

INTERVENTIONS

None.

MAIN VARIABLES

Demographic data, medical history and clinical and laboratory parameters were recorded, along with hematoma volume upon admission and after 24h, and mortality.

RESULTS

A total of 37 patients (24%) received AT. These subjects were older (69 ± 11 vs. 60 ± 15 years, p=0.001) and more frequently diabetic (38% vs. 15%, p=0.003) than those without AT. We detected no difference in hematoma volume upon admission between the two groups, though the volume was significantly greater after 24h in the AT group (66.7 [IQR 42-110] vs. 27 [4.4-64.6]cm(3), p=0.03), irrespective of surgical intervention. Moreover, hematoma volume increased by more than a third in AT-users (69% vs. 33%, p=0.002), and AT was the only significant predictor of hematoma enlargement. Patients on AT also had higher mortality during their ICU stay (78% vs. 45%, p<0.001). In addition, of the patients with hematoma enlargement, over one-third had higher overall mortality (62.5 vs. 28.8%, p=0.001). Independent risk factors for death were the Glasgow Coma Scale score, blood glucose upon admission, and AT.

CONCLUSIONS

Our results show an association between AT and subsequent hematoma enlargement, as well as increased mortality in patients presenting with ICH who were receiving AT.