Role of antiplatelet agents in hematoma expansion during the acute period of intracerebral hemorrhage.
BACKGROUND
Oral anticoagulants have been associated with greater hematoma expansion in patients with intracerebral hemorrhage (ICH). The purpose of this study was to determine whether the reported use of antiplatelet agents also results in greater hematoma expansion.


METHODS
Retrospective review of patients with spontaneous supratentorial ICH diagnosed within 6 h of onset, who underwent follow-up head CT approximately 48 h later. Digital imaging analysis of initial and second CT scans was performed for comparison of hematoma volume changes between patients reporting and those not reporting antecedent antiplatelet use. Statistical analyses to determine predictors of ICH volume change and in-hospital mortality were also performed via multivariate regression models.


RESULTS
Of the 70 patients included, 17 were documented as taking antiplatelet agents. Groups were comparable regarding baseline demographic, clinical and laboratory characteristics, and the timing of CT scans was similar. Patients reporting antiplatelet use experienced greater absolute increase (7.7 ml vs. 5.5 ml) and proportional increase (110% vs. 21%) in ICH volume than those not reporting antiplatelet use, but these differences were not statistically significant (P = 0.94 and 0.61 respectively; Wilcoxon test). Baseline hematoma volume tended to correlate with percentage volume increase (P < 0.1), whereas IVH was inversely associated with percent volume increase (P < 0.05). Age (P < 0.05), absolute volume increase (P < 0.005), and final volume (P < 0.001) were associated with in-hospital mortality, the rates of which were similar between the two study groups (18% vs. 17%).


CONCLUSIONS
Patients reporting antiplatelet use experienced similar degrees of hematoma expansion compared to patients not reporting antiplatelet use.
Division of Cerebrovascular and Critical Care Neurology, Thomas Jefferson Medical Center, 900 Walnut Street, Suite 200, Philadelphia, PA 19107, USA. arista1@pol.net
Michael
M
Moussouttas
Rishi
R
Malhotra
Luis
L
Fernandez
Mitchell
M
Maltenfort
Melissa
M
Holowecki
Jennifer
J
Delgado
Nadine
N
Lawson
Neeraj
N
Badjatia
D000368:Aged; D000369:Aged, 80 and over; D016657:Cerebral Amyloid Angiopathy / Q000150:complications / Q000000981:diagnostic imaging; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D006406:Hematoma / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D020299:Intracranial Hemorrhage, Hypertensive / Q000139:chemically induced / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
D010975:Platelet Aggregation Inhibitors