Objectives: Antiplatelet therapy (APT) promotes bleeding; therefore, APT might worsen outcome in patients with intracerebral hemorrhage (ICH). We performed a systematic review and metaanalysis to address the hypothesis that pre-ICH APT use is associated with mortality and poor functional outcome following ICH. Methods:The Medline and Embase databases were searched in February 2008 using relevant key words, limited to human studies in the English language. Cohort studies of consecutive patients with ICH reporting mortality or functional outcome according to pre-ICH APT use were identified. Of 2,873 studies screened, 10 were judged to meet inclusion criteria by consensus of 2 authors. Additionally, we solicited unpublished data from all authors of cohort studies with Ͼ100 patients published within the last 10 years, and received data from 15 more studies. Univariate and multivariable-adjusted odds ratios (ORs) for mortality and poor functional outcome were abstracted as available and pooled using a random effects model. Results:We obtained mortality data from 25 cohorts (15 unpublished) and functional outcome data from 21 cohorts (14 unpublished). Pre-ICH APT users had increased mortality in both univariate (OR 1.41, 95% confidence interval [CI] 1.21 to 1.64) and multivariable-adjusted (OR 1.27, 95% CI 1.10 to 1.47) pooled analyses. By contrast, the pooled OR for poor functional outcome was no longer significant when using multivariable-adjusted estimates (univariate OR 1.29, 95% CI 1.09 to 1.53; multivariable-adjusted OR 1.10, 95% CI 0.93 to 1.29). Conclusions:In cohort studies, APT use at the time of ICH compared to no APT use was independently associated with increased mortality but not with poor functional outcome. Neurology GLOSSARYAPT ϭ antiplatelet therapy; CI ϭ confidence interval; GOS ϭ Glasgow Outcome Scale; ICH ϭ intracerebral hemorrhage; mRS ϭ modified Rankin Scale; OR ϭ odds ratio.Aspirin or other antiplatelet therapy (APT) could worsen outcome from intracerebral hemorrhage (ICH) by promoting bleeding. Published observational studies of outcomes in pre-ICH APT users have yielded conflicting results, however. Some suggest an increased risk of poor outcome 1-3 while others suggest no increased risk. 4,5 If prior APT worsens outcome, then restoration of normal platelet function could be a therapeutic target.We hypothesized that pre-ICH APT use would be associated with increased mortality and functional impairment following ICH, and tested this hypothesis by performing a systematic review of the literature. To reduce the likelihood of publication bias, we additionally requested information from established cohort studies that had not previously published on the association between pre-ICH APT and clinical outcomes.METHODS Search strategy, selection criteria, and data abstraction. Using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) criteria as a guide, 6 we searched for studies describing mortality or functional outcome of consecutive adults with spontaneous ICH by APT use, ex...

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Frequent amino acid variants in the paraoxonase 1 and paraoxonase 2 genes are associated with sporadic ALS in a Polish population.

Microalbuminuria is a frequent finding in several acute clinical conditions and predicts poor outcome; its role in acute ischemic stroke, however, is unknown. This study was designed to investigate the prevalence and predictive power of microalbuminuria in acute stroke patients and to establish the relationship between microalbuminuria and the patients’ clinical status. We studied 60 patients admitted within 24 h of their first ischemic stroke, 50 patients with a history of ischemic stroke, and 30 control subjects without known cerebrovascular diseases. Neurological deficit was assessed by the Scandinavian Stroke Scale (SSS) on admission and on days 1, 7, 14, and 30. Urinary albumin excretion was measured using immunonephelometric method, with 24-hour collections performed on day 2. Outcome was assessed by 30-day, 90-day and 1-year mortality. Microalbuminuria was found in 46.7% of patients with acute stroke, 16% of subjects with a history of stroke, and 16.7% of controls. On admission, acute stroke patients with microalbuminuria had more severe neurological deficit (median of SSS score on admission was 28 vs. 40, and on day 1, 22 vs. 39, both p < 0.05; Mann-Whitney U test) and more often had a decreased level of consciousness (32 vs. 10%, p < 0.05; Fisher exact test). Mortality was higher in the group of patients with microalbuminuria in acute stroke (21 vs. 3% after 30 days, 39 vs. 6% after 90 days and 50 vs. 9% after 1 year, p < 0.05 for all differences; Fisher exact test). In logistic regression analysis, microalbuminuria was found to be an independent predictor of 1-year mortality after ischemic stroke (OR = 6.0; p = 0.022; 95% CI = 1.3–27.7).