Antiplatelet Therapy after Intracerebral Hemorrhage and Subsequent Clinical Events: A 12-Year South Korean Cohort Study

Moon, Jong Youn; Lee, Jung-Gon; Kim, Jae Hyun

doi:10.1159/000514552

Cited by 5 publications

(8 citation statements)

References 17 publications

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“…These findings alongside published observational studies provide reassurance about the use of long-term antiplatelet therapy after ICH associated with antithrombotic therapy. Since RESTART’s main results were published, 1 stroke guideline has recommended, “In patients with an indication for continued antiplatelet treatment, resuming antiplatelet therapy is reasonable (Evidence Level B).” However, we did not observe a change in participants’ adherence during extended follow-up after the main results were published, so patients and guidelines will require greater strength and certainty of evidence to change clinical practice.…”

Section: Discussionsupporting

confidence: 52%

Effects of Antiplatelet Therapy After Stroke Caused by Intracerebral Hemorrhage

et al. 2021

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IMPORTANCE The Restart or Stop Antithrombotics Randomized Trial (RESTART) found that antiplatelet therapy appeared to be safe up to 5 years after intracerebral hemorrhage (ICH) that had occurred during antithrombotic (antiplatelet or anticoagulant) therapy.OBJECTIVES To monitor adherence, increase duration of follow-up, and improve precision of estimates of the effects of antiplatelet therapy on recurrent ICH and major vascular events.

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Section: Discussionsupporting

confidence: 52%

Effects of Antiplatelet Therapy After Stroke Caused by Intracerebral Hemorrhage

et al. 2021

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“…The results revealed that restarting APT after ICH reduced the occurrence of primary outcome events (nonfatal ICH recurrence, nonfatal ischemic stroke, nonfatal myocardial infarctions; adjusted HR 0.743, 95% CI 0.578–0.956) and all‐cause mortality (adjusted HR 0.740, 95% CI 0.552–0.991) without increasing the risk of recurrent ICH, especially in patients without prior APT. 89 Weimar et al 90 and Viswanathan et al 91 further supported this finding, demonstrating that the usage of antiplatelet medications following ICH treatment in patients was not linked to recurrent ICH. Furthermore, a comprehensive review that included data from nine randomized trials revealed that the overall OR of recurrent ICH in patients taking antithrombotic treatment was 1.00 (95% CI 0.73–1.37, p = 1).…”

Section: Reinitiate Apt Post‐ Ichmentioning

confidence: 87%

“…Moon et al followed up on ICH survivors with clinical events for 12 years. The results revealed that restarting APT after ICH reduced the occurrence of primary outcome events (nonfatal ICH recurrence, nonfatal ischemic stroke, nonfatal myocardial infarctions; adjusted HR 0.743, 95% CI 0.578–0.956) and all‐cause mortality (adjusted HR 0.740, 95% CI 0.552–0.991) without increasing the risk of recurrent ICH, especially in patients without prior APT 89 . Weimar et al 90 and Viswanathan et al 91 further supported this finding, demonstrating that the usage of antiplatelet medications following ICH treatment in patients was not linked to recurrent ICH.…”

Section: Reinitiate Apt Post‐ichmentioning

confidence: 98%

Effect of antiplatelet therapy on the incidence, prognosis, and rebleeding of intracerebral hemorrhage

Liu

Chen

et al. 2023

CNS Neurosci Ther

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Objective Antiplatelet medications are increasingly being used for primary and secondary prevention of ischemic attacks owing to the increasing prevalence of ischemic stroke occurrences. Currently, many patients receive antiplatelet therapy (APT) to prevent thromboembolic events. However, long‐term use of APT might also lead to an increased occurrence of intracerebral hemorrhage (ICH) and affect the prognosis of patients with ICH. Furthermore, some research suggest that restarting APT for patients who have previously experienced ICH may result in rebleeding events. The precise relationship between APT and ICH remains unknown. Methods We searched PubMed for the most recent related literature and summarized the findings from various studies. The search terms included “antiplatelet,” “intracerebral hemorrhage,” “cerebral microbleeds,” “hematoma expansion,” “recurrent,” and “reinitiate.” Clinical studies involving human subjects were ultimately included and interpreted in this review, and animal studies were not discussed. Results When individuals are administered APT, the risk of thrombotic events should be weighted against the risk of bleeding. In general, for some patients’ concomitant with risk factors of thrombotic events, the advantages of antiplatelet medication may outweigh the inherent risk of rebleeding. However, the use of antiplatelet medications for other patients with a higher risk of bleeding should be carefully evaluated and closely monitored. In the future, a quantifiable system for assessing thrombotic risk and bleeding risk will be necessary. After evaluation, the appropriate time to restart APT for ICH patients should be determined to prevent underlying ischemic stroke events. According to the present study results and expert experience, most patients now restart APT at around 1 week following the onset of ICH. Nevertheless, the precise time to restart APT should be chosen on a case‐by‐case basis as per the patient's risk of embolic events and recurrent bleeding. More compelling evidence‐based medicine evidence is needed in the future. Conclusion This review thoroughly discusses the relationship between APT and the development of ICH, the impact of APT on the course and prognosis of ICH patients, and the factors influencing the decision to restart APT after ICH. However, different studies' conclusions are inconsistent due to the differences in quality control. To support future clinical decisions, more large‐scale randomized controlled trials are required.

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“…13 However, in clinical practice, only 5% of patients received antiplatelet therapy within 1 month after ICH. 14 To date, there is no recommendation regarding the appropriate time interval between the presentation of ICH and the resumption of antiplatelet. Using the national cohort database in Taiwan, the aim of this study was to compare the safety outcome between early (≤30 days) and late (31-365 days) antiplatelet resumption in ICH survivors to fill this gap.…”

Section: See Related Article P 546mentioning

confidence: 99%

Early Antiplatelet Resumption and the Risks of Major Bleeding After Intracerebral Hemorrhage

Liu

Hsu

et al. 2023

Stroke

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BACKGROUND: The appropriate timing of resuming antithrombotic therapy after intracerebral hemorrhage (ICH) remains unclear. The aim of this study was to compare the risks of major bleeding between early and late antiplatelet resumption in ICH survivors. METHODS: Between 2008 and 2017, ICH patients were available in the National Health Insurance Research Database. Patients with a medication possession ratio of antiplatelet treatment ≥50% before ICH and after antiplatelet resumption were screened. We excluded patients with atrial fibrillation, heart failure, under anticoagulant or hemodialysis treatment, and developed cerebrovascular events or died before antiplatelet resumption. Finally, 1584 eligible patients were divided into EARLY (≤30 days) and LATE groups (31–365 days after the index ICH) based on the timing of antiplatelet resumption. Patients were followed until the occurrence of a clinical outcome, end of 1-year follow-up, death, or until December 31, 2018. The primary outcome was recurrent ICH. The secondary outcomes included all-cause mortality, major hemorrhagic events, major occlusive vascular events, and ischemic stroke. Cox proportional hazard model after matching was used for comparison between the 2 groups. RESULTS: Both the EARLY and LATE groups had a similar risk of 1-year recurrent ICH (EARLY versus LATE: 3.12% versus 3.27%; adjusted hazard ratio [AHR], 0.967 [95% CI, 0.522–1.791]) after matching. Both groups also had a similar risk of each secondary outcome at 1-year follow-up. Subgroup analyses disclosed early antiplatelet resumption in the patients without prior cerebrovascular disease were associated with lower risks of all-cause mortality (AHR, 0.199 [95% CI, 0.054–0.739]) and major hemorrhagic events (AHR, 0.090 [95% CI, 0.010–0.797]), while early antiplatelet resumption in the patients with chronic kidney disease were associated with a lower risk of ischemic stroke (AHR, 0.065 [95% CI, 0.012–0.364]). CONCLUSIONS: Early resumption of antiplatelet was as safe as delayed antiplatelet resumption in ICH patients. Besides, those without prior cerebrovascular disease or with chronic kidney disease may benefit more from early antiplatelet resumption.

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Antiplatelet Therapy after Intracerebral Hemorrhage and Subsequent Clinical Events: A 12-Year South Korean Cohort Study

Cited by 5 publications

References 17 publications

Effects of Antiplatelet Therapy After Stroke Caused by Intracerebral Hemorrhage

Effects of Antiplatelet Therapy After Stroke Caused by Intracerebral Hemorrhage

Effect of antiplatelet therapy on the incidence, prognosis, and rebleeding of intracerebral hemorrhage

Early Antiplatelet Resumption and the Risks of Major Bleeding After Intracerebral Hemorrhage

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