Arakaki Yoshito, Yoshimura Sohei, Toyoda Kazunori, Sonoda Kazutaka, Wada Shinichi, Nakai Michikazu, Nakahara Jin, Shiozawa Masayuki, Koge Junpei, Ishigami Akiko, Miwa Kaori, Torii-Yoshimura Takako, Miyazaki Junji, Miyamoto Yoshihiro, Minematsu Kazuo, Koga Masatoshi
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
Int J Stroke. 2025 Feb;20(2):166-174. doi: 10.1177/17474930241292022. Epub 2024 Oct 21.
Some patients with intracerebral hemorrhage are on antithrombotic agents at the time of the event and these may worsen outcome, but the relative risk of different oral anticoagulants and antiplatelet agents is uncertain. We determined associations between pre-onset intake of antithrombotic agents and initial stroke severity, and outcomes, in patients with intracerebral hemorrhage.
Patients with intracerebral hemorrhage admitted within 24 h after onset between January 2017 and December 2020 and recruited to the Japan Stroke Data Bank, a hospital-based multicenter prospective registry, were included. Enrolled patients were classified into four groups based on the type of antithrombotic agents being used on admission. The outcomes were the National Institutes of Health Stroke Scale (NIHSS) score on admission and modified Rankin Scale (mRS) of 5-6 at discharge.
Of a total 9810 patients with intracerebral hemorrhage (4267 females; mean age = 70 ± 15 years), 77.1% were classified into the no-antithrombotic group, 13.2% into the antiplatelet group, 4.0% into the warfarin group, and 5.8% into the direct oral anticoagulant (DOAC) group. Median (interquartile range) NIHSS score on admission was 12 (5-22), 13 (5-26), 15 (5-30), and 13 (6-24), respectively, in the four groups. In multivariable analysis, the prestroke warfarin use was associated with higher NIHSS score (adjusted incidence rate ratio = 1.09 (95% confidence interval (CI) = 1.06-1.13), with the no-antithrombotic group as the reference), but the antiplatelet group (1.00 (95% CI = 0.98-1.02)) and DOAC group (0.98 (95% CI = 0.95-1.01)) were not. The rate of mRS 5-6 at discharge was 30.8%, 41.9%, 48.6%, and 41.5%, respectively, in the four groups. In multivariable analysis, prestroke warfarin use was associated with mRS 5-6 (adjusted odds ratio = 1.90 (95% CI = 1.28-2.81), with the no-antithrombotic group as the reference), but the antiplatelet group (1.12 (95% CI = 0.91-1.37)) and DOAC group (1.25 (95% CI = 0.88-1.77)) were not.
Patients who were taking warfarin prior to intracerebral hemorrhage onset suffered more severe intracerebral hemorrhage as evidenced by higher admission NIHSS and higher discharge mRS. In contrast, no increase in severity was seen with antiplatelet agents.
部分脑出血患者在发病时正在服用抗血栓药物，这可能会使预后恶化，但不同口服抗凝剂和抗血小板药物的相对风险尚不确定。我们确定了脑出血患者发病前服用抗血栓药物与初始卒中严重程度及预后之间的关联。
纳入2017年1月至2020年12月发病后24小时内入院并被纳入基于医院的多中心前瞻性登记库——日本卒中数据库的脑出血患者。根据入院时使用的抗血栓药物类型，将入选患者分为四组。结局指标为入院时的美国国立卫生研究院卒中量表（NIHSS）评分及出院时改良Rankin量表（mRS）评分为5 - 6分。
在总共9810例脑出血患者（4267例女性；平均年龄 = 70 ± 15岁）中，77.1%被分类为非抗血栓组，13.2%为抗血小板组，4.0%为华法林组，5.8%为直接口服抗凝剂（DOAC）组。四组患者入院时NIHSS评分的中位数（四分位间距）分别为12（5 - 22）、13（5 - 26）、15（5 - 30）和13（6 - 24）。在多变量分析中，卒中前使用华法林与更高的NIHSS评分相关（调整发病率比 = 1.09（95%置信区间（CI） = 1.06 - 1.13），以非抗血栓组为参照），但抗血小板组（1.00（95% CI = 0.98 - 1.02））和DOAC组（0.98（95% CI = 0.95 - 1.01））则不然。四组患者出院时mRS 5 - 6分的比例分别为30.8%、41.9%、48.6%和41.5%。在多变量分析中，卒中前使用华法林与mRS 5 - 6分相关（调整比值比 = 1.90（95% CI = 1.28 - 2.81），以非抗血栓组为参照），但抗血小板组（1.12（95% CI = 0.91 - 1.37））和DOAC组（1.25（95% CI = 0.88 - 1.77））则不然。
脑出血发病前服用华法林的患者脑出血更严重，这表现为入院时NIHSS评分更高及出院时mRS评分更高。相比之下，抗血小板药物未使严重程度增加。
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