Regular aspirin-use preceding the onset of primary intracerebral hemorrhage is an independent predictor for death.
OBJECTIVE
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.
Saloheimo
Pertti
P
Department of Neurology, Oulu University Hospital, Finland. pertti.saloheimo@fimnet.fi
Ahonen
Mikko
M
Juvela
Seppo
S
Pyhtinen
Juhani
J
Savolainen
Eeva-Riitta
ER
Hillbom
Matti
M
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D000925:Anticoagulants / Q000494:pharmacology; D001241:Aspirin / Q000009:adverse effects* / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006406:Hematoma / Q000473:pathology / Q000628:therapy; D006470:Hemorrhage; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology; D017713:Platelet Transfusion; D012306:Risk; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin