Outcomes in Antiplatelet‐Associated Intracerebral Hemorrhage in the TICH‐2 Randomized Controlled Trial

Law, Zhe Kang; Desborough, Michael; Roberts, Ian; Salman, Rustam Al‐Shahi; England, Timothy J.; Werring, David J.; Robinson, Thompson G.; Krishnan, Kailash; Dineen, Robert A.; Laska, Ann‐Charlotte; Peters, Nils; Egea-Guerrero, Juan José; Karliñski, Michał; Christensen, Hanne; Roffe, Christine; Bereczki, Dániel; Öztürk, Şerefnur; Thanabalan, Jegan; Collins, Rónán; Beridze, Maia; Bath, Philip M; Sprigg, Nikola

doi:10.1161/jaha.120.019130

Cited by 22 publications

(32 citation statements)

References 35 publications

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“…We agree with many other observational and clinical studies finding increased IHM after HS among those taking OACs, warfarin and non-vitamin K antagonist oral anticoagulants (NOACs) and antiplatelet agents prior to hospitalization [18][19][20][21][22][23].…”

Section: Discussionsupporting

confidence: 92%

“…It has been reported that the long-term mortality rate in ICH patients with T2DM is 2.32-fold higher than in those without diabetes [36]. In addition, as expected, and consistent with other investigations, older age, use of OACs and antiplatelet agents, requiring mechanical ventilation, and sepsis were risk factors for IHM in all subgroups [6,8,9,[17][18][19][20][21][22][23]37].…”

Section: Discussionsupporting

confidence: 88%

“…The negative effect of OACs and antiplatelet agents is likely related to a larger baseline hematoma and increased risk of hematoma expansion [18][19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, in the SNHDD, like in databases used in most observational studies, we cannot differentiate the type or number of OACs and antiplatelet agents used, the duration of treatment, and when the last dose was taken [18][19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…Differences in the prevalence of comorbidities and in the use of oral anticoagulants (OACs) and antiplatelet agents according to the presence of T2DM and sex may explain these inconclusive findings [6,8,9,[17][18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

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Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18

López‐de‐Andrés

Jiménez‐García

Hernández‐Barrera

et al. 2021

Cardiovasc Diabetol

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Background To analyze incidence, use of therapeutic procedures, use of oral anticoagulants (OACs) and antiplatelet agents prior to hospitalization, and in-hospital outcomes among patients who were hospitalized with hemorrhagic stroke (HS) according to the presence of type 2 diabetes mellitus (T2DM) in Spain (2016–2018) and to assess the role of sex differences among those with T2DM. Methods Using the Spanish National Hospital Discharge Database we estimated the incidence of HS hospitalizations in men and women aged ≥ 35 years with and without T2DM. Propensity score matching (PSM) was used to compare population subgroups according to sex and the presence of T2DM. Results HS was coded in 31,425 men and 24,975 women, of whom 11,915 (21.12%) had T2DM. The adjusted incidence of HS was significantly higher in patients with T2DM (both sexes) than in non-T2DM individuals (IRR 1.15; 95% CI 1.12–1.17). The incidence of HS was higher in men with T2DM than in T2DM women (adjusted IRR 1.60; 95% CI 1.57–1.63). After PSM, men and women with T2DM have significantly less frequently received decompressive craniectomy than those without T2DM. In-hospital mortality (IHM) was higher among T2DM women than matched non-T2DM women (32.89% vs 30.83%; p = 0.037), with no differences among men. Decompressive craniectomy was significantly more common in men than in matched women with T2DM (5.81% vs. 3.33%; p < 0.001). IHM was higher among T2DM women than T2DM men (32.89% vs. 28.28%; p < 0.001). After adjusting for confounders with multivariable logistic regression, women with T2DM had a 18% higher mortality risk than T2DM men (OR 1.18; 95% CI 1.07–1.29). Use of OACs and antiplatelet agents prior to hospitalization were associated to higher IHM in men and women with and without T2DM. Conclusions T2DM is associated with a higher incidence of HS and with less frequent use of decompressive craniectomy in both sexes, but with higher IHM only among women. Sex differences were detected in T2DM patients who had experienced HS, with higher incidence rates, more frequent decompressive craniectomy, and lower IHM in men than in women.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 88%

“…The negative effect of OACs and antiplatelet agents is likely related to a larger baseline hematoma and increased risk of hematoma expansion [18][19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18

López‐de‐Andrés

Jiménez‐García

Hernández‐Barrera

et al. 2021

Cardiovasc Diabetol

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Haemostatic therapies for stroke due to acute, spontaneous intracerebral haemorrhage

Eilertsen,

Menon,

Law

et al. 2023

Cochrane Database of Systematic Reviews

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Cerebral Amyloid Angiopathy and the Risk of Hematoma Expansion

Seiffge

Polymeris

Law

et al. 2022

Annals of Neurology

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Objective: We assessed whether hematoma expansion (HE) and favorable outcome differ according to type of intracerebral hemorrhage (ICH). Methods: Among participants with ICH enrolled in the TICH-2 (Tranexamic Acid for Hyperacute Primary Intracerebral Haemorrhage) trial, we assessed baseline scans for hematoma location and presence of cerebral amyloid angiopathy (CAA) using computed tomography (CT, simplified Edinburgh criteria) and magnetic resonance imaging (MRI; Boston criteria) and categorized ICH as lobar CAA, lobar non-CAA, and nonlobar. The main outcomes were HE and favorable functional outcome. We constructed multivariate regression models and assessed treatment effects using interaction terms. Results: A total of 2,298 out of 2,325 participants were included with available CT (98.8%; median age = 71 years, interquartile range = 60-80 years; 1,014 female). Additional MRI was available in 219 patients (9.5%). Overall, 1,637 participants (71.2%) had nonlobar ICH; the remaining 661 participants (28.8%) had lobar ICH, of whom 202 patients had lobar CAA-ICH (8.8%, 173 participants according to Edinburgh and 29 participants according to Boston criteria) and 459 did not (lobar non-CAA, 20.0%). For HE, we found a significant interaction of lobar CAA ICH with time from onset to randomization (increasing risk with time, p interaction < 0.001) and baseline ICH volume (constant risk regardless of volume, p interaction < 0.001) but no association between type of ICH and risk of HE or favorable outcome. Tranexamic acid significantly reduced the risk of HE (adjusted odds ratio = 0.7, 95% confidence interval = 0.6-1.0, p = 0.020) without statistically significant interaction with type of ICH (p interaction = 0.058). Tranexamic acid was not associated with favorable outcome. Interpretation: Risk of HE in patients with lobar CAA-ICH was not independently increased but seems to have different dynamics compared to other types of ICH. The time window for treatment of CAA-ICH to prevent HE may be longer.

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Outcomes in Antiplatelet‐Associated Intracerebral Hemorrhage in the TICH‐2 Randomized Controlled Trial

Cited by 22 publications

References 35 publications

Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18

Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18

Haemostatic therapies for stroke due to acute, spontaneous intracerebral haemorrhage

Cerebral Amyloid Angiopathy and the Risk of Hematoma Expansion

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