Is Antiplatelet Therapy for the Prevention of Ischemic Stroke Associated with the Prognosis of Intracerebral Hemorrhage?

Ishibashi, Akira; Yokokura, Yoshitake; Adachi, Hisashi

doi:10.2739/kurumemedj.55.71

Cited by 5 publications

(11 citation statements)

References 11 publications

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“…[4][5][6][7][9][10][11][18][19][20][21][22][23][24][25][26] Eligibility criteria in eight studies included a time restriction. Five studies included patients who arrived at the hospital up to 24 h after symptom onset, 4,5,7,19,24 one study each included patients who had presented within 6 h after symptom onset, 26 had undergone CT within 12 h after onset 22 or up to 14 days after symptom onset. 27 One study only included patients older than 55 years.…”

Section: Literature Searchmentioning

confidence: 99%

“…Ten retrospective, record-based analyses did not indicate criteria used in record-based assessment and were considered at a moderate risk of bias. 5,[9][10][11]15,[19][20][21][22]27 Finally, three studies did not report how they assessed antiplatelet therapy intake. 4,30,31 Most important biases in outcome assessment included large or undefined timespans between symptom onset and imaging for assessment of haematoma volume or haematoma expansion.…”

Section: Risk Of Biasmentioning

confidence: 99%

“…4,30,31 Most important biases in outcome assessment included large or undefined timespans between symptom onset and imaging for assessment of haematoma volume or haematoma expansion. [9][10][11]17,[19][20][21][22][23]26,29,31 Given that haematoma growth occurs in the first few hours, 3 it is possible that a potential haematoma expansion was missed and misinterpreted as larger baseline volume in studies with a long delay between symptom onset and first imaging.…”

Section: Risk Of Biasmentioning

confidence: 99%

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Intracerebral haemorrhage volume, haematoma expansion and 3-month outcomes in patients on antiplatelets. A systematic review and meta-analysis

Goeldlin

Siepen

Mueller

et al. 2021

European Stroke Journal

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Aims We assessed the association of prior antiplatelet therapy (APT) at onset of intracerebral haemorrhage (ICH) with haematoma characteristics and outcome. Methods We performed a systematic review and meta-analysis of studies comparing ICH outcomes of patients on APT (APT-ICH) with patients not taking APT (non–APT-ICH). Primary outcomes were haematoma volume (mean difference and 95% CI), haematoma expansion (HE), in-hospital 3-month mortality rates and good functional outcome (modified Rankin Scale score 0–2). We provide odds ratios (ORs) from random effects models and subgroup analyses for haematoma expansion and short-term mortality rates. Results We included 23 of 1551 studies on 30,949 patients with APT-ICH and 62,018 with non-APT-ICH. Patients on APT were older (Δmean 6.27 years, 95% CI 5.44–7.10), had larger haematoma volume (Δmean 5.74 mL, 95% CI 1.93–9.54), higher short-term mortality rates (OR 1.44, 95% CI 1.14–1.82), 3-month mortality rates (OR 1.58, 95% CI 1.14–2.19) and lower probability of good functional outcome (OR 0.61, 95% CI 0.49–0.77). While there was no difference in HE in the overall analysis (OR 1.32, 95% CI 0.85–2.06), HE occurred more frequently when assessed within 24 h (OR 2.58, 95% CI 1.18–5.67). We found insufficient data for comparison of single versus dual APT-ICH. Heterogeneity was substantial amongst studies. Discussion APT is associated with larger baseline haematoma volume, early (<24 h) haematoma expansion, mortality rates and morbidity in patients with ICH. Data on differences in single and dual APT-ICH are scarce and warrant further investigation. New treatment options for APT-ICH are urgently needed.

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Section: Literature Searchmentioning

confidence: 99%

Section: Risk Of Biasmentioning

confidence: 99%

Section: Risk Of Biasmentioning

confidence: 99%

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Intracerebral haemorrhage volume, haematoma expansion and 3-month outcomes in patients on antiplatelets. A systematic review and meta-analysis

Goeldlin

Siepen

Mueller

et al. 2021

European Stroke Journal

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“…Although the effects of a platelet transfusion on the survival of SICH patients taking antiplatelet agents has been discussed by several authors, there still remains some ambiguity regarding the effect of platelet transfusion on the outcome of SICH 1 , 4 , 6 , 12) . Therefore, large prospective studies are necessary to identify the risk factors for postoperative hematoma enlargement and the value of platelet transfusion in such cases.…”

Section: Discussionmentioning

confidence: 99%

Significant Risk Factors for Postoperative Enlargement of Basal Ganglia Hematoma after Frameless Stereotactic Aspiration : Antiplatelet Medication and Concomitant IVH

Son

Park

2017

J Korean Neurosurg Soc

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ObjectiveFrameless stereotactic aspiration of a hematoma can be the one of the treatment options for spontaneous intracerebral hemorrhage in the basal ganglia. Postoperative hematoma enlargement, however, can be a serious complication of intracranial surgery that frequently results in severe neurological deficit and even death. Therefore, it is important to identify the risk factors of postoperative hematoma growth.MethodsDuring a 13-year period, 101 patients underwent minimally invasive frameless stereotactic aspiration for basal ganglia hematoma. Patients were classified into two groups according to whether or not they had postoperative hematoma enlargement in a computed tomography scan. Baseline demographic data and several risk factors, such as hypertension, preoperative hematoma growth, antiplatelet medication, presence of concomitant intraventricular hemorrhage (IVH), were analysed via a univariate statistical study.ResultsNine of 101 patients (8.9%) showed hematoma enlargement after frameless stereotactic aspiration. Among the various risk factors, concomitant IVH and antiplatelet medication were found to be significantly associated with postoperative enlargement of hematomas.ConclusionIn conclusion, our study revealed that aspirin use and concomitant IVH are factors associated with hematoma enlargement subsequent to frameless stereotactic aspiration for basal ganglia hematoma.

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“…Controversy exists over whether ICH in the setting of antiplatelet use warrants platelet transfusion because the literature is conflicting as to whether antiplatelet agents even contribute to hematoma expansion or to adverse outcomes. Evidence that antiplatelet agents increase hematoma expansion and worsen outcome [Yildiz et al 2011;Creutzfeldt et al 2009;Toyoda et al 2009Toyoda et al , 2005Lacut et al 2007;Sorimachi et al 2007;Saloheimo et al 2006;Roquer et al 2005] is countered by studies that report no increase in hematoma volume or worsened outcome [Moussouttas et al 2010;Sansing et al 2009;Ishibashi et al 2008;Broderick et al 2007b;Foerch et al 2006], and by animal studies showing no differences in volumes or outcomes [Lauer et al 2011].…”

Section: Antiplatelet Agentsmentioning

confidence: 99%

Challenges and controversies in the medical management of primary and antithrombotic-related intracerebral hemorrhage

Moussouttas¹

2011

Ther Adv Neurol Disord

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Intracerebral hemorrhage (ICH) represents 10-15% of all cerebrovascular events, and is associated with substantial morbidity and mortality. In contrast to ischemic cerebrovascular disease in which acute therapies have proven beneficial, ICH remains a more elusive condition to treat, and no surgical procedure has proven to be beneficial. Aspects pertinent to medical ICH management include cessation or minimization of hematoma enlargement, prevention of intraventricular extension, and treatment of edema and mass effect. Therapies focusing on these aspects include prothrombotic (hemostatic) agents, antihypertensive strategies, and antiedema therapies. Therapies directed towards the reversal of antithrombosis caused by antiplatelet and anticoagulant agents are frequently based on limited data, allowing for diverse opinions and practice styles. Several newer anticoagulants that act by direct thrombin or factor Xa inhibition have no natural antidote, and are being increasingly used for various prophylactic and therapeutic indications. As such, these new anticoagulants will inevitably pose major challenges in the treatment of patients with ICH. Ongoing issues in the management of patients with ICH include the need for effective treatments that not only limit hematoma expansion but also result in improved clinical outcomes, the identification of patients at greatest risk for continued hemorrhage who may most benefit from treatment, and the initiation of therapies during the hyperacute period of most active hemorrhage. Defining hematoma volume increases at various anatomical locations that translate into clinically meaningful outcomes will also aid in directing future trials for this disease. The focus of this review is to underline and discuss the various controversies and challenges involved in the medical management of patients with primary and antithrombotic-related ICH.

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Is Antiplatelet Therapy for the Prevention of Ischemic Stroke Associated with the Prognosis of Intracerebral Hemorrhage?

Cited by 5 publications

References 11 publications

Intracerebral haemorrhage volume, haematoma expansion and 3-month outcomes in patients on antiplatelets. A systematic review and meta-analysis

Intracerebral haemorrhage volume, haematoma expansion and 3-month outcomes in patients on antiplatelets. A systematic review and meta-analysis

Significant Risk Factors for Postoperative Enlargement of Basal Ganglia Hematoma after Frameless Stereotactic Aspiration : Antiplatelet Medication and Concomitant IVH

Challenges and controversies in the medical management of primary and antithrombotic-related intracerebral hemorrhage

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