Published Online
on June 29, 2006

A more recent version of this article appeared on August 1, 2006

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Submitted on February 18, 2006
Revised on April 2, 2006
Accepted on May 4, 2006

Pretreatment With Antiplatelet Agents Is Not Independently Associated With Unfavorable Outcome in Intracerebral Hemorrhage

Christian Foerch MD^*; Matthias Sitzer MD; Helmuth Steinmetz MD; Tobias Neumann-Haefelin MD; for the Arbeitsgruppe Schlaganfall Hessen

From the Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.

^* To whom correspondence should be addressed. E-mail: foerch{at}em.uni-frankfurt.de.

Background and Purpose--This study investigated the effect of preexisting antiplatelet therapy on mortality and functional outcome in patients with intracerebral hemorrhage (ICH).

Methods--Our analysis was based on a large, country-wide stroke registry in Germany. All parameters relevant to this analysis, including age, prehospital status (according to the modified Rankin Scale, mRS), International Classification of Diseases-based diagnosis, and pretreatment with antiplatelet agents or oral anticoagulants, were recorded prospectively. Main outcome measures were in-hospital mortality rate and functional status at hospital discharge (mRS).

Results--Over a 2-year period, 1691 patients with ICH (ICD-10: I61) were documented (48% female; mean age, 72±12 years). At symptom onset, 26% were taking antiplatelet agents, and 12% were taking oral anticoagulants. By univariate logistic regression, pretreatment with antiplatelet drugs or anticoagulants was found to be a significant predictor of in-hospital mortality (odds ratio [OR], 1.42; P=0.008; OR, 1.53; P<0.001) and of an unfavorable functional outcome (defined as mRS >2 or death; OR, 1.33, P=0.039; OR, 1.51; P<0.001). However, after adjustment for age and prehospital status, antiplatelet pretreatment was no longer an independent risk factor of in-hospital death (OR, 1.12; P=0.490) or unfavorable functional outcome (OR, 0.97; P=0.830), whereas the influence of pretreatment with oral anticoagulants remained significant (OR, 1.45; P<0.001; OR, 1.42; P=0.009).

Conclusions--In contrast to oral anticoagulants, pretreatment with antiplatelet agents is not an independent risk factor of mortality and unfavorable outcome in patients with ICH.

Key words: antiplatelet agents • cerebral hemorrhage • outcome

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