title: Antiplatelet therapies are associated with hematoma enlargement and increased mortality in intracranial hemorrhage.
abstract: OBJECTIVE
  Antiplatelet therapy (AT) is increasingly used for treating or preventing vascular diseases, especially as a consequence of population aging. However, the risks may sometimes outweigh the benefits, mostly in relation to intracranial hemorrhage (ICH). Our aim was to determine whether AT is associated with hematoma enlargement and increased mortality in ICH.
  
  
  METHODS
  A prospective, observational cohort study.
  
  
  METHODS
  The Intensive Care Unit (ICU) of Arrixaca University Hospital (Murcia, Spain).
  
  
  METHODS
  We studied 156 patients admitted with non-traumatic ICH between January 2006 and August 2008.
  
  
  METHODS
  None.
  
  
  METHODS
  Demographic data, medical history and clinical and laboratory parameters were recorded, along with hematoma volume upon admission and after 24h, and mortality.
  
  
  RESULTS
  A total of 37 patients (24%) received AT. These subjects were older (69 ± 11 vs. 60 ± 15 years, p=0.001) and more frequently diabetic (38% vs. 15%, p=0.003) than those without AT. We detected no difference in hematoma volume upon admission between the two groups, though the volume was significantly greater after 24h in the AT group (66.7 [IQR 42-110] vs. 27 [4.4-64.6]cm(3), p=0.03), irrespective of surgical intervention. Moreover, hematoma volume increased by more than a third in AT-users (69% vs. 33%, p=0.002), and AT was the only significant predictor of hematoma enlargement. Patients on AT also had higher mortality during their ICU stay (78% vs. 45%, p<0.001). In addition, of the patients with hematoma enlargement, over one-third had higher overall mortality (62.5 vs. 28.8%, p=0.001). Independent risk factors for death were the Glasgow Coma Scale score, blood glucose upon admission, and AT.
  
  
  CONCLUSIONS
  Our results show an association between AT and subsequent hematoma enlargement, as well as increased mortality in patients presenting with ICH who were receiving AT.
authors.affiliation: Intensive Care Unit, Hospital Virgen de Arrixaca, Murcia, Spain. josehdegea@hotmail.com
authors.forename: J H
authors.initials: JH
authors.lastname: de Gea-García
authors.forename: M
authors.initials: M
authors.lastname: Fernández-Vivas
authors.forename: R
authors.initials: R
authors.lastname: Núñez-Ruiz
authors.forename: M
authors.initials: M
authors.lastname: Rubio-Alonso
authors.forename: I
authors.initials: I
authors.lastname: Villegas
authors.forename: M
authors.initials: M
authors.lastname: Martínez-Fresneda
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006406:Hematoma / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D007362:Intensive Care Units; D020300:Intracranial Hemorrhages / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D011446:Prospective Studies
chemical_list: D010975:Platelet Aggregation Inhibitors