title: Variation in restarting antithrombotic drugs at hospital discharge after intracerebral hemorrhage.
abstract: OBJECTIVE
  Whether intracerebral hemorrhage (ICH) survivors should restart antithrombotic drugs is unknown. We analyzed the frequency of restarting antithrombotic drugs in ICH survivors who had taken prophylactic antithrombotic drugs in atrial fibrillation or after thromboembolic disease in 5 cohorts and explored factors associated with doing so.
  
  
  METHODS
  We compared the characteristics and proportions of patients taking antithrombotic drugs at ICH onset and discharge in 4 hospital-based cohorts (Lille, France, n=542; Utrecht, The Netherlands, n=389; multicenter Clinical Relevance of Microbleeds in Stroke-2 (CROMIS-2) ICH, United Kingdom, n=667; and Amsterdam, The Netherlands, n=403) and 1 community-based study (Lothian, Scotland, n=137), using bivariate analyses. We sought characteristics associated with restarting using bivariate and multivariable logistic regression analyses.
  
  
  RESULTS
  A total of 942 (44%) patients with ICH took antithrombotic drugs at hospital admission (no difference between cohorts). Antithrombotic drugs were restarted in 96 (20%) of the 469 survivors who had taken antithrombotic drugs for secondary prevention or atrial fibrillation, but this proportion differed when stratified by the cohort of origin (Lille, 18%; Utrecht, 45%; Lothian, 15%; CROMIS-2 ICH, 11%; Amsterdam, 20%; P<0.001) and by type of antithrombotic drug pre-ICH (14% in patients with previous antiplatelet drugs versus 26% in patients with previous vitamin K antagonists and 41% in patients with both drugs; P<0.001). We did not find other consistent, independent associations with restarting antithrombotic drugs.
  
  
  CONCLUSIONS
  The variation in clinical practice and lack of consistent associations with restarting antithrombotic drugs after ICH reflect current knowledge and support the need for randomized controlled trials to resolve this dilemma.
authors.affiliation: From the Department of Neurology, Université Lille Nord de France, UDSL, EA 1046, Lille, France (M.P., C.C.); Department of Neurology, Université Catholique de Lille, Lille, France (M.P.); Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom (A.C., D.J.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (C.J.J.v.A., C.J.M.K.); Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.I.B., Y.B.R.); and Division of Clinical Neurosciences, Center for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom (N.S., R.A.-S.S.).
authors.forename: Marta
authors.initials: M
authors.lastname: Pasquini
authors.affiliation: From the Department of Neurology, Université Lille Nord de France, UDSL, EA 1046, Lille, France (M.P., C.C.); Department of Neurology, Université Catholique de Lille, Lille, France (M.P.); Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom (A.C., D.J.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (C.J.J.v.A., C.J.M.K.); Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.I.B., Y.B.R.); and Division of Clinical Neurosciences, Center for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom (N.S., R.A.-S.S.).
authors.forename: Andreas
authors.initials: A
authors.lastname: Charidimou
authors.affiliation: From the Department of Neurology, Université Lille Nord de France, UDSL, EA 1046, Lille, France (M.P., C.C.); Department of Neurology, Université Catholique de Lille, Lille, France (M.P.); Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom (A.C., D.J.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (C.J.J.v.A., C.J.M.K.); Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.I.B., Y.B.R.); and Division of Clinical Neurosciences, Center for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom (N.S., R.A.-S.S.).
authors.forename: Charlotte J J
authors.initials: CJ
authors.lastname: van Asch
authors.affiliation: From the Department of Neurology, Université Lille Nord de France, UDSL, EA 1046, Lille, France (M.P., C.C.); Department of Neurology, Université Catholique de Lille, Lille, France (M.P.); Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom (A.C., D.J.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (C.J.J.v.A., C.J.M.K.); Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.I.B., Y.B.R.); and Division of Clinical Neurosciences, Center for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom (N.S., R.A.-S.S.).
authors.forename: Merih I
authors.initials: MI
authors.lastname: Baharoglu
authors.affiliation: From the Department of Neurology, Université Lille Nord de France, UDSL, EA 1046, Lille, France (M.P., C.C.); Department of Neurology, Université Catholique de Lille, Lille, France (M.P.); Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom (A.C., D.J.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (C.J.J.v.A., C.J.M.K.); Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.I.B., Y.B.R.); and Division of Clinical Neurosciences, Center for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom (N.S., R.A.-S.S.).
authors.forename: Neshika
authors.initials: N
authors.lastname: Samarasekera
authors.affiliation: From the Department of Neurology, Université Lille Nord de France, UDSL, EA 1046, Lille, France (M.P., C.C.); Department of Neurology, Université Catholique de Lille, Lille, France (M.P.); Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom (A.C., D.J.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (C.J.J.v.A., C.J.M.K.); Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.I.B., Y.B.R.); and Division of Clinical Neurosciences, Center for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom (N.S., R.A.-S.S.).
authors.forename: David J
authors.initials: DJ
authors.lastname: Werring
authors.affiliation: From the Department of Neurology, Université Lille Nord de France, UDSL, EA 1046, Lille, France (M.P., C.C.); Department of Neurology, Université Catholique de Lille, Lille, France (M.P.); Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom (A.C., D.J.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (C.J.J.v.A., C.J.M.K.); Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.I.B., Y.B.R.); and Division of Clinical Neurosciences, Center for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom (N.S., R.A.-S.S.).
authors.forename: Catharina J M
authors.initials: CJ
authors.lastname: Klijn
authors.affiliation: From the Department of Neurology, Université Lille Nord de France, UDSL, EA 1046, Lille, France (M.P., C.C.); Department of Neurology, Université Catholique de Lille, Lille, France (M.P.); Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom (A.C., D.J.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (C.J.J.v.A., C.J.M.K.); Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.I.B., Y.B.R.); and Division of Clinical Neurosciences, Center for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom (N.S., R.A.-S.S.).
authors.forename: Yvo B
authors.initials: YB
authors.lastname: Roos
authors.affiliation: From the Department of Neurology, Université Lille Nord de France, UDSL, EA 1046, Lille, France (M.P., C.C.); Department of Neurology, Université Catholique de Lille, Lille, France (M.P.); Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom (A.C., D.J.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (C.J.J.v.A., C.J.M.K.); Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.I.B., Y.B.R.); and Division of Clinical Neurosciences, Center for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom (N.S., R.A.-S.S.).
authors.forename: Rustam
authors.initials: R
authors.lastname: Al-Shahi Salman
authors.affiliation: From the Department of Neurology, Université Lille Nord de France, UDSL, EA 1046, Lille, France (M.P., C.C.); Department of Neurology, Université Catholique de Lille, Lille, France (M.P.); Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom (A.C., D.J.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (C.J.J.v.A., C.J.M.K.); Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.I.B., Y.B.R.); and Division of Clinical Neurosciences, Center for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom (N.S., R.A.-S.S.). charlotte.cordonnier@chru-lille.fr.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Cordonnier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000188:drug therapy* / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D010351:Patient Discharge; D012044:Regression Analysis; D012606:Scotland; D013923:Thromboembolism / Q000517:prevention & control; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents
keywords: antithrombotic agents; cerebral hemorrhage; cohort studies