title: Short-term prognosis of intracranial haemorrhage in patients on oral anticoagulant or antiplatelet drugs.
abstract: BACKGROUND
  Intracranial haemorrhage (ICH) is the most feared complication of oral vitamin K antagonists (VKAs) and antiplatelet drugs. Little data are available on the clinical course of antithrombotic drug-associated ICHICH. The main aim of the VKA- and Antiplatelet Drug-Associated ICH Prognosis (VAIP) study is to investigate predictors of short-term prognosis in ICH patients, and to analyse characteristics and prognosis of patients with antithrombotic drugs-associated ICH.
  
  
  METHODS
  VAIP is designed as a retrospective cohort study. Consecutive adult patients with an ICH objectively documented by neuroimaging, occurring during treatment with VKAs or ADs, admitted to the Cuneo hospital, Italy, from 2005 to 2010, were included. For a non-exposed group, we randomly selected patients with ICH not on antithrombotic treatment.
  
  
  RESULTS
  Overall, 451 patients were included. In particular, 75 patients were on VKAs and 96 on antiplatelet drugs. The site of haemorrhage was intracerebral in 274 (60.8%) patients, subdural in 156 (34.6%), and subarachnoid in 21 (4.7%). Mortality rate was 35.8%, 4.5%, and 28.6%, respectively. In the multivariate analysis, independent predictors of in-hospital death were: age >80years (hazard ratio [HR] 2.3, 95% confidence interval 1.5-3.5), Glasgow Coma Scale [GCS]<8 (HR 7.8, 5.0-12.1), treatment with VKAs (HR 2.0, 1.2-3.4) and antiplatelet drugs (HR 1.8, 1.1-3.0). Neurosurgical treatment was an independent predictor of survival (HR 0.5, 0.3-1.0). Among patients with VKA-associated ICH, independent predictors of in-hospital death for ICH were: age >80years (HR 4.4, 1.6-12.0), GCS <8 (HR 12.0, 4.1-34.8), recent onset of symptoms (HR 4.2, 1.6-11.3), and neurosurgical treatment (HR 0.1, 0.0-0.8).
  
  
  CONCLUSIONS
  Our results suggest that the main predictors of ICH in-hospital prognosis in a tertiary neurosurgical center are advanced age, GCS at admission, previous treatment with VKAs and antiplatelet drugs, and neurosurgical treatment.
authors.affiliation: Department of Internal Medicine, 'S. Croce e Carle' Hospital, Cuneo, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Pomero
authors.forename: Remo
authors.initials: R
authors.lastname: Melchio
authors.forename: Anna
authors.initials: A
authors.lastname: Sironi
authors.forename: Alessia Valentina
authors.initials: AV
authors.lastname: Giraudo
authors.forename: Francesco
authors.initials: F
authors.lastname: Dentali
authors.forename: Luigi Maria
authors.initials: LM
authors.lastname: Fenoglio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Squizzato
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors