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(Stroke. 2007;38:864.)
© 2007 American Heart Association, Inc.

Letters to the Editor

Response to Letter by Roquer

Department of Neurology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Response:

We thank Dr Roquer for the comments on our article. The study by Roquer et al was designed to identify independent predictors of 30-day mortality in intracerebral hemorrhage (ICH) out of a large number of variables.¹ In contrast to the results of our study,² they found previous use of antiplatelets to be an independent predictor of 30-day mortality in 194 consecutive ICH patients. In our study, univariate analysis initially suggested the same result, but multivariate logistic regression showed this to be subject to bias in terms of age and prehospital disability.

What might explain the discrepant results? In the study by Roquer et al, we suspect relevant differences in important baseline variables between patients with and without previous antiplatelet use. In detail, 26 of 47 antiplatelet users (55%!) had received antiplatelets as "secondary stroke prevention". The proportion of patients having had a previous stroke in the nonantiplatelet group is not given but was likely substantially lower. In addition, whereas patients with a premorbid modified Rankin Scale score >2 were excluded, no adjustment was made for premorbid modified Rankin Scale scores between 0 to 2. Finally, the analysis focused solely on 30-day mortality and would have been strengthened by additional data on outcome of ICH survivors.

Regarding the specific points of criticism on our study, we do not believe that it is necessary to include initial clinical severity as a parameter into the multivariate model. When we designed our analysis, we anticipated that antiplatelet therapy could be associated with severe . . . [Full Text of this Article]