Antithrombotic pretreatment increases very-early mortality in primary intracerebral hemorrhage.
OBJECTIVE
To analyze the effect of previous antiplatelet (AP) and vitamin K antagonist (VKA) treatments on outcome in patients with primary intracerebral hemorrhage (ICH).


METHODS
In this prospective observational study, we analyzed 529 patients according to antithrombotic pretreatment: none, AP, or VKA. Very-early (24-hour) death, 3-month mortality, and functional independence were analyzed.


RESULTS
Of 236 (44.6%) pretreated patients, 147 (27.8%) patients were taking AP and 89 (16.8%) VKA. Very-early death was observed in 13.4% and was increased in pretreated patients: 19.0% for AP and 27.0% for VKA treatment, compared to 6.5% in non-pretreated patients,p< 0.0001. Three-month mortality was 40.8% overall (49.7% for AP pretreated, 58.4% for VKA pretreated, and 31.1% for non-pretreated patients,p< 0.0001). The adjusted odds of very-early and 3-month mortality were 2.55 (p= 0.004) and 1.56 (p= 0.046) for AP-pretreated patients and 4.24 (p< 0.0001) and 2.34 (p= 0.01) for VKA-pretreated patients, respectively, compared with non-pretreated patients. The effect of antithrombotic pretreatment on mortality from 24 hours to 3 months was nonsignificant. At 3-month follow-up, 28.5% of patients remained functionally independent: 22.4% of AP-pretreated, 15.7% of VKA-pretreated, and 35.5% of non-pretreated patients (p< 0.0001).


CONCLUSIONS
A high percentage of patients with ICH preventively treated with VKA or AP died during the first 24 hours after admission. Both treatments were predictors of very-early mortality. The final effect of antithrombotics on 3-month mortality remains significant through its strong effect on very-early mortality. Safety concerns about starting chronic antithrombotic treatment should be considered not only when VKA treatment is planned but also for AP treatment.
From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., A.R.C., J.J.C.), Universitat Autònoma de Barcelona; and DCEXS (E.C.G.), Universitat Pompeu Fabra, Barcelona, Spain. jroquer@hospitaldelmar.cat.
Jaume
J
Roquer
From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., A.R.C., J.J.C.), Universitat Autònoma de Barcelona; and DCEXS (E.C.G.), Universitat Pompeu Fabra, Barcelona, Spain.
Rosa María
RM
Vivanco Hidalgo
From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., A.R.C., J.J.C.), Universitat Autònoma de Barcelona; and DCEXS (E.C.G.), Universitat Pompeu Fabra, Barcelona, Spain.
Angel
A
Ois
From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., A.R.C., J.J.C.), Universitat Autònoma de Barcelona; and DCEXS (E.C.G.), Universitat Pompeu Fabra, Barcelona, Spain.
Ana
A
Rodríguez Campello
From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., A.R.C., J.J.C.), Universitat Autònoma de Barcelona; and DCEXS (E.C.G.), Universitat Pompeu Fabra, Barcelona, Spain.
Elisa
E
Cuadrado Godia
From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., A.R.C., J.J.C.), Universitat Autònoma de Barcelona; and DCEXS (E.C.G.), Universitat Pompeu Fabra, Barcelona, Spain.
Eva
E
Giralt Steinhauer
From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., A.R.C., J.J.C.), Universitat Autònoma de Barcelona; and DCEXS (E.C.G.), Universitat Pompeu Fabra, Barcelona, Spain.
Alejandra
A
Gómez González
From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., A.R.C., J.J.C.), Universitat Autònoma de Barcelona; and DCEXS (E.C.G.), Universitat Pompeu Fabra, Barcelona, Spain.
Carolina
C
Soriano-Tarraga
From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., A.R.C., J.J.C.), Universitat Autònoma de Barcelona; and DCEXS (E.C.G.), Universitat Pompeu Fabra, Barcelona, Spain.
Jordi
J
Jiménez Conde
D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D014812:Vitamin K / Q000819:agonists*
D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K