title: Antithrombotic Medication Use and Misuse Among Patients with Intracranial Hemorrhage: A 16-Year, Lebanese, Single-Center Experience.
abstract: OBJECTIVE
  The use of antithrombotic medication (ATM) frequently is reported in patients with intracranial hemorrhage (ICH) and is associated with increased mortality. Unfortunately, ATMs sometimes are prescribed and/or used inappropriately. We sought to determine the rate of ATM misprescription/misuse among patients with ICH in a single-center retrospective study.
  
  
  METHODS
  All patients admitted with ATM-related ICH in 1998-2014 were included. Charts were reviewed and demographic, clinical, and radiologic variables were recorded. The type of ATM, dose, and duration of treatment were analyzed critically. The adequacy of ATM prescription/use was assessed in light of the recommendations and guidelines of the American Heart Association, American Stroke Association, and French National Authority for Health, in effect at the time of admission.
  
  
  RESULTS
  A total of 106 patients with mean age 68 years were identified. Aspirin (53.8%) was the most commonly used drug, followed by oral anticoagulants (31.1%) and clopidogrel (22.6%). In only 80 patients (75.5%), the use of ATM was in line with contemporary guidelines. In the remaining 26 (24.5%), the use of ATMs was inappropriate, including bad drug combination, wrong dose, poor indication, wrong drug class, and/or incorrect treatment duration.
  
  
  CONCLUSIONS
  In this Lebanese cohort of patients with ICH, the 24.5% rate of ATM misprescription and/or misuse is highly alarming and the origin of this problem is likely multifactorial. Immediate measures should be undertaken, and efforts should be focused on regaining tight control of ATM prescription and fulfillment, ensuring good patient education, and offering more vigilant oversight on physician licensure.
authors: Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon.
authors: Elie
authors: E
authors: Fahed
authors: Department of Radiology, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon.
authors: Jessica
authors: J
authors: Ghauche
authors: Department of Neurosciences, Virginia Commonwealth University School of Medicine - Inova Campus, Falls Church, Virginia, USA.
authors: Ralph
authors: R
authors: Rahme
authors: Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon.
authors: Nabil
authors: N
authors: Okais
authors: Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon.
authors: Elie
authors: E
authors: Samaha
authors: Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon.
authors: Georges
authors: G
authors: Nohra
authors: Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon.
authors: Tony
authors: T
authors: Rizk
authors: Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon.
authors: Joseph
authors: J
authors: Maarrawi
authors: Department of Radiology, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon.
authors: Lina
authors: L
authors: Menassa-Moussa
authors: Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon. Electronic address: ronald_moussa@hotmail.com.
authors: Ronald
authors: R
authors: Moussa
mesh_terms: D000074:Acenocoumarol / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000188:drug therapy; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D020300:Intracranial Hemorrhages / Q000453:epidemiology*; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D000074:Acenocoumarol; D013988:Ticlopidine; D001241:Aspirin
keywords: Anticoagulant; Antiplatelet; Antithrombotic; Intracerebral hemorrhage; Intracranial hemorrhage; Subarachnoid hemorrhage