Raffaele Ornello, MD

Sprügel MI, Kuramatsu JB, Gerner ST, Sembill JA, Beuscher VD, Hagen M, et al. Antiplatelet therapy in primary spontaneous and oral anticoagulation–associated intracerebral hemorrhage. Stroke. 2018

The exact effect of antiplatelet therapy (APT) on the characteristics and outcome of intracerebral hemorrhage (ICH) is interesting especially among patients treated with oral anticoagulation (OAC).

The present pooled analysis of two retrospective cohort studies and a prospective single-center study assessed the influence of APT on the characteristics and functional outcome of ICH in patients with primary spontaneous ICH, vitamin K antagonist (VKA)-associated ICH, and non-VKA-OAC (NOAC)-associated ICH. Compared with patients with VKA-associated ICH not under APT, those with VKA-associated ICH under APT had a lower proportion of 3-month favorable outcome, defined as modified Rankin Scale scores 0-3, higher 3-month mortality, and larger hematoma volume; on the other hand, APT did not influence the characteristics and outcome of ICH among patients with primary spontaneous or NOAC-associated ICH.

The study limitations were the large amount of retrospective data, the manual method of volume calculations, the relatively low rates of hematoma expansion, the limited statistical power for analyses involving NOAC-associated ICH, and the lack of specific numbers for interrater reliability, measurement of platelet function, and data of cerebral amyloid angiopathy or apolipoprotein E; however, the study is the largest analysis, to date, assessing the influence of APT on the characteristics and outcome of ICH. The study data provide evidence to limit the combined treatment with VKAs and APT to carefully selected patients.