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(Stroke. 2006;37:129.)
© 2006 American Heart Association, Inc.

Original Contributions

Regular Aspirin-Use Preceding the Onset of Primary Intracerebral Hemorrhage is an Independent Predictor for Death

Pertti Saloheimo, MD; Mikko Ahonen, MD; Seppo Juvela, MD, PhD; Juhani Pyhtinen, MD, PhD; Eeva-Riitta Savolainen, MD, PhD Matti Hillbom, MD, PhD

From the Department of Neurology, Oulu University Hospital, Finland (P.S, M.A., M.H.); the Department of Neurosurgery, Helsinki University Central Hospital, Finland (S.J.); the Department of Diagnostic Radiology, Oulu University Hospital, Finland (J.P.); the Department of Hematology (E.-R.S.), Oulu University Hospital, Finland.

Correspondence to Pertti Saloheimo, MD, Aurorankuja 4 E 20, 02940 Espoo, Finland. E-mail pertti.saloheimo{at}fimnet.fi

Background and Purpose— Hematoma volume and impaired level of consciousness are the most potent predictors of outcome after spontaneous intracerebral hemorrhage (ICH). The effect of preceding aspirin-use on outcome after ICH is poorly investigated. We investigated short-term mortality and hematoma enlargement in subjects with ICH to find the predictors for these outcomes.

Methods— This population-based study included all subjects with ICH during a period of 33 months in the population of Northern Ostrobothnia, Finland. The subjects were identified, and their clinical characteristics and outcomes were checked from hospital records or death records.

Results— Three-month mortality of the 208 identified subjects with ICH was 33%. The independent risk factors for death were regular aspirin-use at the onset of ICH (relative risks [RR], 2.5; 95% CI, 1.3 to 4.6; P=0.004), warfarin-use at the onset of ICH (RR, 3.2; 95% CI, 1.6 to 6.1; P=0.001), and ICH score higher than 2 on admission (RR, 13.8; 95% CI, 6.0 to 31.4; P<0.001). Regular aspirin-use preceding the onset of ICH associated significantly with hematoma enlargement during the first week after ICH (P=0.006).

Conclusions— We observed poor short-term outcomes and increased mortality, probably attributable to rapid enlargement of hematomas, in the subjects with ICH who had been taking regularly moderate doses of aspirin (median 250 mg) immediately before the onset of the stroke.

Key Words: aspirin • cerebral hemorrhage • mortality • warfarin

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Aspirin-Use Before ICH: A Potentially Treatable Iatrogenic Coagulopathy?

Stanley Tuhrim
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