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Antiplatelet Therapy After Spontaneous Intracerebral Hemorrhage and Functional Outcomes.

TitleAntiplatelet Therapy After Spontaneous Intracerebral Hemorrhage and Functional Outcomes.
Publication TypeJournal Article
Year of Publication2019
AuthorsMurthy SB, Biffi A, Falcone GJ, Sansing LH, Lopez VTorres, Navi BB, Roh DJ, Mandava P, Hanley DF, Ziai WC, Kamel H, Rosand J, Sheth KN
Corporate AuthorsVISTA-ICH Steering Committee Collaborators
JournalStroke
Volume50
Issue11
Pagination3057-3063
Date Published2019 11
ISSN1524-4628
KeywordsAged, Aged, 80 and over, Cerebral Hemorrhage, Disease-Free Survival, Female, Humans, Longitudinal Studies, Male, Meta-Analysis as Topic, Middle Aged, Platelet Aggregation Inhibitors, Registries, Survival Rate, Thromboembolism, Time Factors
Abstract

Background and Purpose- Observational data suggest that antiplatelet therapy after intracerebral hemorrhage (ICH) alleviates thromboembolic risk without increasing the risk of recurrent ICH. Given the paucity of data on the relationship between antiplatelet therapy after ICH and functional outcomes, we aimed to study this association in a multicenter cohort. Methods- We meta-analyzed data from (1) the Massachusetts General Hospital ICH registry (n=1854), (2) the Virtual International Stroke Trials Archive database (n=762), and (3) the Yale stroke registry (n=185). Our exposure was antiplatelet therapy after ICH, which was modeled as a time-varying covariate. Our primary outcomes were all-cause mortality and a composite of major disability or death (modified Rankin Scale score 4-6). We used Cox proportional regression analyses to estimate the hazard ratio of death or poor functional outcome as a function of antiplatelet therapy and random-effects meta-analysis to pool the estimated HRs across studies. Additional analyses stratified by hematoma location (lobar and deep ICH) were performed. Results- We included a total of 2801 ICH patients, of whom 288 (10.3%) were started on antiplatelet medications after ICH. Median times to antiplatelet therapy ranged from 7 to 39 days. Antiplatelet therapy after ICH was not associated with mortality (hazard ratio, 0.85; 95% CI, 0.66-1.09), or death or major disability (hazard ratio, 0.83; 95% CI, 0.59-1.16) compared with patients not started on antiplatelet therapy. Similar results were obtained in additional analyses stratified by hematoma location. Conclusions- Antiplatelet therapy after ICH appeared safe and was not associated with all-cause mortality or functional outcome, regardless of hematoma location. Randomized clinical trials are needed to determine the effects and harms of antiplatelet therapy after ICH.

DOI10.1161/STROKEAHA.119.025972
Alternate JournalStroke
PubMed ID31895618
PubMed Central IDPMC6941441
Grant ListU01 NS080824 / NS / NINDS NIH HHS / United States
P30 AG021342 / AG / NIA NIH HHS / United States
R01 NR018335 / NR / NINR NIH HHS / United States
R24 NS092983 / NS / NINDS NIH HHS / United States
U24 NS107215 / NS / NINDS NIH HHS / United States
K23 NS100816 / NS / NINDS NIH HHS / United States
R01 NS097728 / NS / NINDS NIH HHS / United States
K23 NS105948 / NS / NINDS NIH HHS / United States
R01 NS095993 / NS / NINDS NIH HHS / United States
UL1 TR001863 / TR / NCATS NIH HHS / United States
R01 NS093870 / NS / NINDS NIH HHS / United States
U01 NS095869 / NS / NINDS NIH HHS / United States
UM1 HG008895 / HG / NHGRI NIH HHS / United States
R01 NS036695 / NS / NINDS NIH HHS / United States
K76 AG059992 / AG / NIA NIH HHS / United States
R03 NS112859 / NS / NINDS NIH HHS / United States
R01 NS097443 / NS / NINDS NIH HHS / United States
U24 TR001609 / TR / NCATS NIH HHS / United States
U01 NS106513 / NS / NINDS NIH HHS / United States
U24 NS107136 / NS / NINDS NIH HHS / United States
K23 NS091395 / NS / NINDS NIH HHS / United States

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