Murthy Santosh, Roh David J, Chatterjee Abhinaba, McBee Nichol, Parikh Neal S, Merkler Alexander E, Navi Babak B, Falcone Guido J, Sheth Kevin N, Awad Issam, Hanley Daniel, Kamel Hooman, Ziai Wendy C
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurolgy, Weill Cornell Medicine, New York, NY, United States
Neurology, Columbia University Irving Medical Center, New York, New York, USA.
J Neurol Neurosurg Psychiatry. 2020 Oct 26. doi: 10.1136/jnnp-2020-323458.
To evaluate the relationship between prior antiplatelet therapy (APT) and outcomes after primary intracerebral haemorrhage (ICH), and assess if it varies by haematoma location.
We pooled individual patient data from the Virtual International Stroke Trials Archive-ICH trials dataset, Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage III trial and the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation Phase III trial. The exposure was APT preceding ICH diagnosis. The primary outcome was haematoma expansion at 72 hours. Secondary outcomes were admission haematoma volume, all-cause mortality, death or major disability (modified Rankin Scale (mRS) score ≥4) and shift in mRS distribution. Mixed-effects models were used to assess the relationship between APT and outcomes. Secondary analyses were stratified by ICH location and study cohort.
Among 1420 patients with ICH, there were 782 (55.1%) lobar and 596 (42.0%) deep haemorrhages. APT was reported in 284 (20.0%) patients. In adjusted regression models, prior APT was not associated with haematoma expansion (OR, 0.97; 95% CI 0.60 to 1.57), major disability or death (OR, 1.05; 95% CI 0.61 to 1.63), all-cause mortality (OR, 0.89; 95% CI 0.47 to 1.85), admission haematoma volume (beta, -0.17; SE, 0.09; p=0.07) and shift in mRS (p=0.43). In secondary analyses, APT was associated with admission haematoma volume in lobar ICH (beta, 0.25; SE, 0.12; p=0.03), but there was no relationship with other ICH outcomes when stratified by haematoma location or study cohort.
In a large heterogeneous cohort of patients with ICH, prior APT was not associated with haematoma expansion or functional outcomes after ICH, regardless of haematoma location. APT was associated with admission haematoma volumes in lobar ICH.
评估原发性脑出血（ICH）前的抗血小板治疗（APT）与预后之间的关系，并评估其是否因血肿部位而异。
我们汇总了来自虚拟国际卒中试验档案-ICH试验数据集、脑室出血加速溶解评估III试验以及微创外科手术联合阿替普酶治疗脑出血清除III试验的个体患者数据。暴露因素为ICH诊断前的APT。主要结局为72小时时血肿扩大。次要结局为入院时血肿体积、全因死亡率、死亡或严重残疾（改良Rankin量表（mRS）评分≥4）以及mRS分布变化。采用混合效应模型评估APT与结局之间的关系。次要分析按ICH部位和研究队列进行分层。
在1420例ICH患者中，有782例（55.1%）为脑叶出血，596例（42.0%）为深部出血。284例（20.0%）患者报告接受了APT。在调整后的回归模型中，既往APT与血肿扩大（比值比，0.97；95%置信区间0.60至1.57）、严重残疾或死亡（比值比，1.05；95%置信区间0.61至1.63）、全因死亡率（比值比，0.89；95%置信区间0.47至1.85）、入院时血肿体积（β，-0.17；标准误，0.09；p = 0.07）以及mRS变化（p = 0.43）均无关联。在次要分析中，APT与脑叶ICH的入院时血肿体积相关（β，0.25；标准误，0.12；p = 0.03），但按血肿部位或研究队列分层时，与其他ICH结局均无关系。
在一个大型异质性ICH患者队列中，无论血肿部位如何，既往APT与ICH后的血肿扩大或功能结局均无关联。APT与脑叶ICH的入院时血肿体积相关。
