Key result
Early antiplatelet resumption (≤30 days) after intracerebral hemorrhage had a similar risk of 1-year recurrent ICH compared to late resumption (3.12% vs 3.27%; AHR 0.967, 95% CI 0.522-1.791).
Why the study?
The appropriate timing of resuming antithrombotic therapy after intracerebral hemorrhage remains unclear.
Does early antiplatelet resumption compared to late resumption affect the risk of recurrent ICH in intracerebral hemorrhage survivors?
Cohort (n=1,584)
Does early antiplatelet resumption compared to late resumption affect the risk of recurrent ICH in intracerebral hemorrhage survivors?
Hazard Ratio: 0.967 (95% CI 0.522–1.791)
Absolute Event Rate: 3.12% vs 3.27%
Early resumption of antiplatelet therapy (≤30 days) after intracerebral hemorrhage appears as safe as delayed resumption (31-365 days) regarding the risk of recurrent ICH at 1 year.
Early resumption after ICH associated with similar recurrent ICH risk; hypothesis-generating and requires RCT confirmation before practice change.
BACKGROUND: The appropriate timing of resuming antithrombotic therapy after intracerebral hemorrhage (ICH) remains unclear. The aim of this study was to compare the risks of major bleeding between early and late antiplatelet resumption in ICH survivors. METHODS: Between 2008 and 2017, ICH patients were available in the National Health Insurance Research Database. Patients with a medication possession ratio of antiplatelet treatment ≥50% before ICH and after antiplatelet resumption were screened. We excluded patients with atrial fibrillation, heart failure, under anticoagulant or hemodialysis treatment, and developed cerebrovascular events or died before antiplatelet resumption. Finally, 1584 eligible patients were divided into EARLY (≤30 days) and LATE groups (31-365 days after the index ICH) based on the timing of antiplatelet resumption. Patients were followed until the occurrence of a clinical outcome, end of 1-year follow-up, death, or until December 31, 2018. The primary outcome was recurrent ICH. The secondary outcomes included all-cause mortality, major hemorrhagic events, major occlusive vascular events, and ischemic stroke. Cox proportional hazard model after matching was used for comparison between the 2 groups. RESULTS: Both the EARLY and LATE groups had a similar risk of 1-year recurrent ICH (EARLY versus LATE: 3.12% versus 3.27%; adjusted hazard ratio [AHR], 0.967 [95% CI, 0.522-1.791]) after matching. Both groups also had a similar risk of each secondary outcome at 1-year follow-up. Subgroup analyses disclosed early antiplatelet resumption in the patients without prior cerebrovascular disease were associated with lower risks of all-cause mortality (AHR, 0.199 [95% CI, 0.054-0.739]) and major hemorrhagic events (AHR, 0.090 [95% CI, 0.010-0.797]), while early antiplatelet resumption in the patients with chronic kidney disease were associated with a lower risk of ischemic stroke (AHR, 0.065 [95% CI, 0.012-0.364]). CONCLUSIONS: Early resumption of antiplatelet was as safe as delayed antiplatelet resumption in ICH patients. Besides, those without prior cerebrovascular disease or with chronic kidney disease may benefit more from early antiplatelet resumption.
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Liu et al. (2023) conducted a cohort in Intracerebral hemorrhage (ICH) (n=1,584). Early antiplatelet resumption (≤30 days) vs. Late antiplatelet resumption (31-365 days) was evaluated on recurrent ICH (AHR 0.967, 95% CI 0.522-1.791). Early antiplatelet resumption (≤30 days) after intracerebral hemorrhage had a similar risk of 1-year recurrent ICH compared to late resumption (3.12% vs 3.27%; AHR 0.967, 95% CI 0.522-1.791).
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