title: Antithrombotic medications and the etiology of intracerebral hemorrhage: MUCH-Italy.
abstract: OBJECTIVE
  To test the hypothesis that the effect of antithrombotic medications on the risk of intracerebral hemorrhage (ICH) varies according to the location of the hematoma.
  
  
  METHODS
  Consecutive patients with ICH were enrolled as part of the Multicenter Study on Cerebral Hemorrhage in Italy (MUCH-Italy). Multivariable logistic regression models served to examine whether risk factors for ICH and location of the hematoma (deep vs lobar) predict treatment-specific ICH subgroups (antiplatelets-related ICH and oral anticoagulants [OACs]-related ICH).
  
  
  RESULTS
  A total of 870 (313 lobar ICH, 557 deep ICH) subjects were included. Of these, 223 (25.6%) were taking antiplatelets and 77 (8.8%) OACs at the time of stroke. The odds of antiplatelet-related ICH increased with aging (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.03-1.07) and hypertension (OR 1.86; 95% CI 1.22-2.85) but had no relation with the anatomical location of ICH. Conversely, lobar location of the hematoma was associated with the subgroup of OAC-related ICH (OR 1.70; 95% CI 1.03-2.81) when compared to the subgroup of patients taking no antithrombotic medications. Within the subgroup of patients taking OACs, international normalized ratio (INR) values were higher in those with lobar ICH as compared to those with deep ICH (2.8 ± 1.1 vs 2.2 ± 0.8; p = 0.011). The proportion of patients with lobar hematoma increased with increasing intensity of anticoagulation, with a ~2-fold increased odds of lobar compared to deep ICH (odds 2.17; p = 0.03) in those exposed to overanticoagulation (INR values >3.0).
  
  
  CONCLUSIONS
  OACs, as opposed to antiplatelets, predispose to lobar location of brain hematomas according to a dose-response relationship.
authors.affiliation: From the Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (A. Pezzini, P.C., L.P., A.M., V.D.G., A. Padovani), and Divisione di Biologia e Genetica, Dipartimento di Medicina Molecolare e Traslazionale (M.R., M.C.), Università degli Studi di Brescia; Dipartimento di Scienze del Sistema Nervoso e del Comportamento (M. Grassi, D.P.), Unità di Statistica Medica e Genomica, Università di Pavia; Stroke Unit and Divisione di Medicina Cardiovascolare (M.P., V.C., G.A.), Università di Perugia; Stroke Unit (A.Z., M.L.D., A.M.S.), Clinica Neurologica, Nuovo Ospedale Civile "S. Agostino Estense," AUSL Modena; U.O di Neurologia (G.S., A.L., A.C.), Ospedale "C. Poma," Mantova; U.O. di Recupero e Rieducazione Funzionale (E.D.Z.), IRCCS Fondazione Don Gnocchi, Rovato; U.O Neurologia (A.G., I.V.), Istituto Clinico "S. Anna," Brescia; and Stroke Unit (M. Gamba), Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pezzini
authors.forename: Mario
authors.initials: M
authors.lastname: Grassi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Paciaroni
authors.forename: Andrea
authors.initials: A
authors.lastname: Zini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Silvestrelli
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Del Zotto
authors.forename: Valeria
authors.initials: V
authors.lastname: Caso
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Dell'Acqua
authors.forename: Alessia
authors.initials: A
authors.lastname: Giossi
authors.forename: Irene
authors.initials: I
authors.lastname: Volonghi
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Simone
authors.forename: Alessia
authors.initials: A
authors.lastname: Lanari
authors.forename: Paolo
authors.initials: P
authors.lastname: Costa
authors.forename: Loris
authors.initials: L
authors.lastname: Poli
authors.forename: Andrea
authors.initials: A
authors.lastname: Morotti
authors.forename: Valeria
authors.initials: V
authors.lastname: De Giuli
authors.forename: Daniele
authors.initials: D
authors.lastname: Pepe
authors.forename: Massimo
authors.initials: M
authors.lastname: Gamba
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ciccone
authors.forename: Marco
authors.initials: M
authors.lastname: Ritelli
authors.forename: Marina
authors.initials: M
authors.lastname: Colombi
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Padovani
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D020145:Basal Ganglia Hemorrhage / Q000000981:diagnostic imaging / Q000473:pathology; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D001933:Brain Stem / Q000000981:diagnostic imaging / Q000473:pathology; D002531:Cerebellum / Q000000981:diagnostic imaging / Q000473:pathology; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000175:diagnosis*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000150:complications; D007558:Italy; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D012307:Risk Factors; D013788:Thalamus / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors