Key result
Pre-ICH warfarin use, but not antiplatelet use, was associated with significantly increased 6-month case fatality in patients with spontaneous ICH (adjusted HR 2.75; 95% CI 2.04-3.72; P<0.001).
Why the study?
Does pre-ICH use of warfarin or antiplatelets increase 6-month case fatality in patients with acute spontaneous intracerebral hemorrhage?
Cohort (n=2,021)
No
Does pre-ICH use of warfarin or antiplatelets increase 6-month case fatality in patients with acute spontaneous intracerebral hemorrhage?
Hazard Ratio: 2.75 (95% CI 2.04–3.72)
p-value: p=< 0.001
Prior use of warfarin, but not antiplatelets, is associated with significantly higher 6-month mortality and worse baseline hemorrhage characteristics in patients presenting with spontaneous intracerebral hemorrhage.
BACKGROUND AND PURPOSE: Anticoagulant and antiplatelets for prevention of ischaemic stroke and cardiovascular diseases may increase the risk of intracerebral hemorrhage (ICH). This study aimed to investigate the influence of pre-ICH use of anticoagulant and antiplatelets on ICH patients. METHODS: Consecutive patients with acute spontaneous ICH registered in a single-center stroke registry during 2001 to 2010 were analyzed and categorized according to their pre-ICH use of warfarin (Group I), antiplatelets (Group II), or neither (Group III). Survival analysis and the Cox proportional hazard model were used to compare between the three groups and the predictors. RESULTS: Of 2021 ICH patients (male, 63.3%; mean age, 62.6 ± 14.4 years) included, there were 94 (4.7%) in Group I, 232 (11.4%) in Group II, and 1695 (83.9%) in Group III. Warfarin users had larger hematoma volume, more intraventricular extension, higher frequencies of lobar ICH, and higher case fatality than non-warfarin users (Groups II and III). The Cox proportional hazard model showed increased 6-month case fatality in pre-ICH warfarin users (adjusted hazard ratio 2.75, 95% confidence interval 2.04-3.72, P < 0.001), but not in pre-ICH antiplatelet users (adjusted hazard ratio 0.95, 95% confidence interval 0.72-1.26). CONCLUSIONS: Intracerebral hemorrhage patients with prior warfarin use, but not antiplatelet use, had significantly higher case fatality at 6 months.
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Chen et al. (2012) conducted a cohort in acute spontaneous intracerebral hemorrhage (ICH) (n=2,021). Pre-ICH warfarin use vs. Non-warfarin use (antiplatelets or neither) was evaluated on 6-month case fatality (HR 2.75, 95% CI 2.04-3.72, p=< 0.001). Pre-ICH warfarin use, but not antiplatelet use, was associated with significantly increased 6-month case fatality in patients with spontaneous ICH (adjusted HR 2.75; 95% CI 2.04-3.72; P<0.001).
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