Abstract WP368: The Association of Prior Use of Antiplatelet Agents and Increased Mortality and Morbidity in Intracerebral Hemorrhage Patients
Introduction: Use of anti-platelet therapy is common among patients presenting with intracerebral hemorrhage (ICH). There are limited data regarding pre-stroke antiplatelet therapy (APT) and outcomes in patients presenting with spontaneous ICH. We hypothesized that prior use of antiplatelet agents increases mortality and discharge morbidity in ICH patients.
Methods: We analyzed data of 82,576 ICH patients not on anticoagulation from 2185 GWTG-Stroke hospitals between Oct 2012 and March 2016. Patients were categorized as no APT, single antiplatelet therapy (SAPT) and dual antiplatelet therapy (DAPT). Logistic regression using generalized estimating equations to account for within-site correlations were used to assess the relationship between outcomes and prior-APT use.
Results: No pre-ICH APT was used in 65.8%, SAPT in 29.5%, and DAPT in 4.8%. The median age of the cohort was 69 years and prevalence of females in the cohort was 48.6%, with preponderance of white race (58.9%). Overall onset of symptoms to arrival time was 131 minutes with a median NIHSS of 9. A total of 23.7% had history of previous stroke/transient ischemic attack, 15.3% had prior myocardial infarction/coronary artery disease and 73.4% had known hypertension. There was no significant difference in in-hospital mortality among patients not on any APT vs patients on SAPT. However, in-hospital mortality was higher among ICH patients on DAPT compared with no therapy (adjusted OR 1.41, 95 % CI 1.31-1.51, P<0.0001).
Conclusion: Our study suggests that patients on DAPT, but not on SAPT, have higher mortality rates after ICH compared with patients on no APT.
Author Disclosures: N. Khan: Research Grant; Modest; AHA Young Investigator Database Seed Grant. F. Siddiqui: Research Grant; Modest; AHA Young Investigator Database Seed Grant. J. Goldstein: Research Grant; Significant; Pfizer, Portola pharmaceuticals, Boehringer Ingelheim. Consultant/Advisory Board; Significant; Bristol Myers Squibb. Y. Xian: None. M. Cox: None. R. Matsouaka: Employment; Significant; Duke University. Research Grant; Significant; NHLBI/North Carolina State University, STS Data Warehouse and Analysis Center, American College of Cardiology/Society of Thoracic Surgeons, Patient-Centered Outcomes Research Institute, Michigan Society of Thoracic & Cardiovascular Surgeons Quality Collaborative. P. Heidenreich: None. E. Peterson: Research Grant; Significant; Janssen. Consultant/Advisory Board; Significant; Janssen, Boehringer Ingelhiem, Sanofi, Bayer, Merck, Astra Zeneca, Signal Path, Venable. D.L. Bhatt: Research Grant; Significant; Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Pfizer, Roche, Sanofi Aventis,, Amgen, The Medicines Company. G. Fonarow: Research Grant; Significant; Patient-Centered Outcomes Research Institute. L. Schwamm: Research Grant; Significant; Patient-Centered Outcomes Research Institute. Consultant/Advisory Board; Significant; Medtronic. E.E. Smith: None.
This research has received full or partial funding support from the American Heart Association, Midwest Affiliate – Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota, Wisconsin.
- © 2017 by American Heart Association, Inc.