Jørgensen Christian Mistegård, Boe Nils Jensen, Hald Stine Munk, Meyer-Kristensen Frederik, Norlén Mie Micheelsen, Ovesen Christian, Möller Sören, Høyer Birgit Bjerre, Bojsen Jonas Asgaard, Elhakim Mohammad Talal, Harbo Frederik Severin Gråe, Al-Shahi Salman Rustam, Goldstein Larry B, Hallas Jesper, García Rodríguez Luis Alberto, Selim Magdy, Gaist David
Research Unit for Neurology, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark.
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Clin Epidemiol. 2024 Dec 5;16:837-848. doi: 10.2147/CLEP.S493499. eCollection 2024.
To estimate the strength of association between use of antithrombotics (AT) drugs with survival after spontaneous intracerebral hemorrhage (s-ICH) comparing oral anticoagulant (OAC) or platelet antiaggregants (PA) with no AT use and in active comparator analyses OAC vs PA, direct oral anticoagulant (DOAC) vs vitamin K antagonist (VKA), and clopidogrel vs aspirin.
We identified patients ≥55 years with a first-ever s-ICH between 2015 and 2018 in Southern Denmark (population 1.2 million). From this population, patients who had used an AT at the time of ICH were identified and classified as OAC or PA vs no AT (reference group), and for active comparator analyses as OAC vs PA (reference group), DOAC vs VKA (reference group), or clopidogrel vs aspirin (reference group). We calculated adjusted relative risks (aRRs) and corresponding [95% confidence intervals] for 90-day all-cause mortality with adjustments for potential confounders.
Among 1043 patients who had s-ICH, 206 had used an OAC, 270 a PA, and 428 had no AT use. The adjusted 90-day mortality was higher in OAC- (aRR 1.68 [1.39-2.02]) and PA-users (aRR 1.21 [1.03-1.42]), compared with no AT. Mortality was higher in OAC- (aRR 1.19 [1.05-1.36]) vs PA-users. In analyses by antithrombotic drug type, 88 used a DOAC, 136 a VKA, 111 clopidogrel, and 177 aspirin. Mortality was lower among DOAC- vs VKA-users (aRR 0.82 [0.68-0.99]), but similar between clopidogrel vs aspirin users (aRR 1.04 [0.87-1.24]).
In this unselected cohort from a geographically defined Danish population, 90-day mortality after s-ICH was higher in patients with prior use of an OAC compared with no AT use or patients using a PA. Mortality was slightly lower for patients using a DOAC than a VKA. Mortality was also higher in PA- vs no AT-users, but there were no differences in mortality between clopidogrel vs aspirin.
评估使用抗血栓药物（AT）与自发性脑出血（s-ICH）后生存率之间的关联强度，比较口服抗凝剂（OAC）或血小板抗聚集剂（PA）与未使用AT的情况，并在活性对照分析中比较OAC与PA、直接口服抗凝剂（DOAC）与维生素K拮抗剂（VKA）以及氯吡格雷与阿司匹林。
我们确定了2015年至2018年在丹麦南部（人口120万）首次发生s-ICH且年龄≥55岁的患者。在该人群中，识别出ICH时使用过AT的患者，并将其分类为OAC或PA与未使用AT（参照组），在活性对照分析中分类为OAC与PA（参照组）、DOAC与VKA（参照组）或氯吡格雷与阿司匹林（参照组）。我们计算了调整后的相对风险（aRRs）以及90天全因死亡率的相应[95%置信区间]，并对潜在混杂因素进行了调整。
在1043例发生s-ICH的患者中，206例使用过OAC，270例使用过PA，428例未使用AT。与未使用AT相比，OAC使用者（aRR 1.68[1.39 - 2.02]）和PA使用者（aRR 1.21[1.03 - 1.42]）的调整后90天死亡率更高。OAC使用者（aRR 1.19[1.05 - 1.36]）的死亡率高于PA使用者。在按抗血栓药物类型进行的分析中，88例使用DOAC，136例使用VKA，111例使用氯吡格雷，177例使用阿司匹林。DOAC使用者的死亡率低于VKA使用者（aRR 0.82[0.68 - 0.99]），但氯吡格雷使用者与阿司匹林使用者之间的死亡率相似（aRR 1.04[0.87 - 1.24]）。
在这个来自丹麦特定地理区域的未选择队列中，与未使用AT或使用PA的患者相比，先前使用OAC的患者s-ICH后90天死亡率更高。使用DOAC的患者死亡率略低于使用VKA的患者。PA使用者的死亡率也高于未使用AT的患者，但氯吡格雷与阿司匹林使用者之间的死亡率没有差异。
