Romem Roy, Tanne David, Geva Diklah, Einhorn-Cohen Michal, Shlomo Nir, Bar-Yehuda Sara, Harnof Sagi
The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Stroke Cerebrovasc Dis. 2018 Nov;27(11):3380-3386. doi: 10.1016/j.jstrokecerebrovasdis.2018.07.040. Epub 2018 Sep 9.
Intracerebral hemorrhage (ICH) is the most disastrous stroke subtype. Prognosis is considered worse with prior antithrombotic treatment. Our aim was to evaluate the association of prior antithrombotic treatment on the radiological and clinical outcome after ICH in a subgroup of patients included in a national registry.
Based on the National Acute Stroke Israeli (NASIS) registry during 2004, 2007, 2010, and 2013 (2-month periods), characteristics, volumetric parameters, and prognosis of a subgroup of patients with ICH were analyzed.
Among the 634 patients with ICH in the NASIS registry, 310 (49%) were not treated previously with antithrombotic medications, 232 (37%) were treated with an antiplatelet agent, and 92 (14.5%) patients were on oral anticoagulant therapy, of them 30 patients (33%) with an international normalised ratio (INR) value below 2, 33 (36%) patients with an INR value of 2-3, and 29 patients (31%) with an INR value above 3 upon admission. Patients with deep hemorrhage on prior anticoagulants treatment had the highest probability for poor outcome at hospital discharge. Patients with low bleeding volume (0-30 cm), were likely to have admission National Institute of Health Stroke Scale < 10 (62%), while those with higher volumes (30-59 cm and > 60 cm), had only 16.7% and 14.3% chance, respectively. We did not observe a significant difference between prior antithrombotic treatment and functional outcome at discharge, yet prior anticoagulant treatment was associated with higher long-term mortality rates.
Our findings, based on a national registry, support the high mortality and poor outcome of anticoagulant related ICH.
脑出血（ICH）是最具灾难性的卒中亚型。既往抗栓治疗被认为会使预后更差。我们的目的是在纳入国家登记系统的一组患者中，评估既往抗栓治疗与脑出血后影像学及临床结局之间的关联。
基于2004年、2007年、2010年和2013年（为期2个月）的以色列国家急性卒中（NASIS）登记系统，对一组脑出血患者的特征、体积参数及预后进行分析。
在NASIS登记系统的634例脑出血患者中，310例（49%）既往未接受抗栓药物治疗，232例（37%）接受抗血小板药物治疗，92例（14.5%）接受口服抗凝治疗，其中30例（33%）患者入院时国际标准化比值（INR）低于2，33例（36%）患者INR值为2 - 3，29例（31%）患者INR值高于3。既往接受抗凝治疗且发生深部出血的患者出院时预后不良的可能性最高。出血量少（0 - 30 cm³）的患者入院时美国国立卫生研究院卒中量表评分< 10分的可能性为62%，而出血量较大（30 - 59 cm³和> 60 cm³）的患者这一可能性分别仅为16.7%和14.3%。我们未观察到既往抗栓治疗与出院时功能结局之间存在显著差异，但既往抗凝治疗与较高的长期死亡率相关。
基于国家登记系统的我们的研究结果，支持抗凝相关脑出血的高死亡率和不良结局。
