Location of acute brain hemorrhage in patients undergoing antithrombotic therapy.
BACKGROUND
The relationship between antithrombotic therapy and the anatomical location of acute brain hematoma remains disputed. The current study was therefore designed to address this issue.


METHODS
The medical records and CT images were retrospectively reviewed in 484 consecutive patients with an acute brain hemorrhage (291 men, 193 women; mean age, 67.2+/-12.3 years) who were admitted to the hospital within 7 days of stroke onset from January 1999 through October 2003. Antithrombotic therapy had been performed in 116 patients (AT Group): warfarin (n=38), antiplatelet therapy (n=70), or both (n=8). The other 368 patients had not received antithrombotic therapy (non-AT Group). The hematoma location was compared among the groups.


RESULTS
The location of the hematoma was significantly different between the two groups (p<0.0001). The following locations were seen more frequently in the AT Group than in the non-AT Group: thalamic hemorrhage (44.8% vs. 30.7%), cerebellar hemorrhage (7.8% vs. 2.7%), and lobar hemorrhage (18.1% vs. 11.4%). The clinical characteristics in patients with thalamic, cerebellar, or lobar hemorrhage were compared with those with putaminal hemorrhage. A multivariate analysis using the logistic regression model showed that antithrombotic therapy was an independent factor for cerebellar hemorrhage (OR 3.66, 95%CI 1.31-10.18), lobar hemorrhage (OR 2.27, 95%CI 1.12-4.57), and thalamic hemorrhage (OR 2.20, 95%CI 1.06-4.54) in comparison to putaminal hemorrhage.


CONCLUSIONS
It therefore appears that antithrombotic therapy is independently associated with thalamic, cerebellar, and lobar hemorrhage.
Itabashi
Ryo
R
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, Japan. ritabash@kohnan-sendai.or.jp
Yasaka
Masahiro
M
Kuwashiro
Takahiro
T
Nakagaki
Hideaki
H
Miyashita
Fumio
F
Naritomi
Hiroaki
H
Minematsu
Kazuo
K
D000368:Aged; D001921:Brain / Q000187:drug effects / Q000473:pathology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000188:drug therapy* / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin