title: In-hospital mortality after pre-treatment with antiplatelet agents or oral anticoagulants and hematoma evacuation of intracerebral hematomas.
abstract: Pre-treatment with antiplatelet agents is described to be a risk factor for mortality after spontaneous intracerebral hemorrhage (ICH). However, the impact of antithrombotic agents on mortality in patients who undergo hematoma evacuation compared to conservatively treated patients with ICH remains controversial. This analysis is based on a prospective registry for quality assurance in stroke care in the State of Hesse, Germany. Patients' data were collected between January 2008 and December 2012. Only patients with the diagnosis of spontaneous ICH were included (International Classification of Diseases 10th Revision codes I61.0-I61.9). Predictors of in-hospital mortality were determined by univariate analysis. Predictors with P<0.1 were included in a binary logistic regression model. The binary logistic regression model was adjusted for age, initial Glasgow Coma Score (GCS), the presence of intraventricular hemorrhage (IVH), and pre-ICH disability prior to ictus. In 8,421 patients with spontaneous ICH, pre-treatment with oral anticoagulants or antiplatelet agents was documented in 16.3% and 25.1%, respectively. Overall in-hospital mortality was 23.2%. In-hospital mortality was decreased in operatively treated patients compared to conservatively treated patients (11.6% versus 24.0%; P<0.001). Patients with antiplatelet pre-treatment had a significantly higher risk of death during the hospital stay after hematoma evacuation (odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.24-4.97; P=0.010) compared to patients without antiplatelet pre-treatment treatment (OR: 0.9; 95% CI: 0.79-1.09; P=0.376). In conclusion a higher rate of in-hospital mortality after pre-treatment with antiplatelet agents in combination with hematoma evacuation after spontaneous ICH was observed in the presented cohort.
authors.affiliation: Department of Neurosurgery, Justus-Liebig University, Klinikstrasse 33, 35392 Giessen, Germany. Electronic address: Marco.Stein@neuro.med.uni-giessen.de.
authors.forename: Marco
authors.initials: M
authors.lastname: Stein
authors.affiliation: Institute of Quality Assurance Hesse, Eschborn, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Misselwitz
authors.affiliation: Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Guenzburg, Germany.
authors.forename: Gerhard F
authors.initials: GF
authors.lastname: Hamann
authors.affiliation: Department of Neurosurgery, Justus-Liebig University, Klinikstrasse 33, 35392 Giessen, Germany.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Kolodziej
authors.affiliation: Department of Neurosurgery, Justus-Liebig University, Klinikstrasse 33, 35392 Giessen, Germany.
authors.forename: Marcus H T
authors.initials: MH
authors.lastname: Reinges
authors.affiliation: Department of Neurosurgery, Justus-Liebig University, Klinikstrasse 33, 35392 Giessen, Germany.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Uhl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006407:Hematoma, Epidural, Cranial / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors
keywords: Conservative therapy; Hematoma evacuation; Intracerebral haemorrhage; Outcome