Abstract T P342: Impact of the Type of Prior Antithrombotic Agents on Secondary Hemorrhagic Stroke: Location, Severity and Outcome
Introduction: Randomized trials and meta-analyses have shown the efficacy of antithrombotic therapies to prevent secondary ischemic stroke. However, hemorrhagic event is a major complication of long-term antithrombotic therapy affecting poor outcomes and increased mortality, which has not been fully investigated. Here, we examined the impact of the type of prior antithrombotic agents on secondary hemorrhagic stroke.
Methods: Using multicenter retrospective study of stroke risk in antithrombotic therapy (RESTATE) database, 1067 consecutive patients who presented secondary stroke during antithrombotic therapy were registered. Among them, patients showing secondary hemorrhagic stroke were analyzed in detail regarding the type of antithrombotic agent; aspirin, ticlopidine, clopidogrel, cilostazol and warfarin.
Results: Two hundred and fifty seven patients presented secondary hemorrhagic stroke; 144 patients in aspirin (20.5%), 15 patients in ticlopidine (16.3%), 17 patients in clopidogrel (13.7%), 23 patients in cilostazol (16.0%) and 58 patients in warfarin (21.8%). Thalamus was the most common location (27.7%) following putamen (24.4%), cerebral cortex (24.4%), cerebellum (12.2%), and brain stem (4.7%). Multivariate analysis found that male sex (OR: 0.73, 95% CI: 0.54-0.98, P=0.04), INR >1.4 (OR: 2.72, 95% CI: 1.77-4.19, P<0.001) and antihypertensive therapy (OR: 0.64, 95% CI: 0.45-0.91, P=0.01) were independently associated with secondary hemorrhagic stroke. Interestingly, only the presence of cilostazol significantly affected lower hemorrhage volume compared with other agents in basal ganglia hemorrhage (P=0.03), and only the presence of clopidogrel significantly affected higher hemorrhage volume compared with other agents in subcortical hemorrhage (P<0.001). Finally, only the patients taking cilostazol had significantly higher favorable outcome (mRS 0-2) at 3 months after the secondary hemorrhagic stroke.
Conclusions: We first provide the evidence that female sex, INR>1.4 and non-antihypertensive therapy could be risk factors for the secondary hemorrhagic stroke. Location and hemorrhage volume could be different depending on the type of antithrombotic agent, which affect outcome of secondary stroke.
Author Disclosures: N. Horie: None. M. Kaminogo: None. T. Hirao: None. M. Fukushima: None. A. Izaki: None. K. Mori: None. A. Shibayama: None. W. Haraguchi: None. K. Shirakawa: None. M. Hirose: None. H. Takahata: None. A. Tsujino: None. G. So: None. T. Izumo: None. K. Nagasato: None. I. Nagata: None.
- © 2014 by American Heart Association, Inc.