Outcomes in antiplatelet-associated intracerebral hemorrhage in the tich-2 randomized controlled trial
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- JAHA.120.019130
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BACKGROUND: Antiplatelet therapy increases the risk of hematoma expansion in intracerebral hemorrhage (ICH) while the effect on functional outcome is uncertain. METHODS AND RESULTS: This is an exploratory analysis of the TICH-2 (Tranexamic Acid in Intracerebral Hemorrhage-2) double-blind, randomized, placebo-controlled trial, which studied the efficacy of tranexamic acid in patients with spontaneous ICH within 8 hours of onset. Multivariable logistic regression and ordinal regression were performed to explore the relationship between pre-ICH an-tiplatelet therapy, and 24-hour hematoma expansion and day 90 modified Rankin Scale score, as well as the effect of tranexamic acid. Of 2325 patients, 611 (26.3%) had pre-ICH antiplatelet therapy. They were older (mean age, 75.7 versus 66.5 years), more likely to have ischemic heart disease (25.4% versus 2.7%), ischemic stroke (36.2% versus 6.3%), intraventricular hemorrhage (40.2% versus 27.5%), and larger baseline hematoma volume (mean, 28.1 versus 22.6 mL) than the no-antiplatelet group. Pre-ICH antiplatelet therapy was associated with a significantly increased risk of hematoma expansion (adjusted odds ratio [OR], 1.28; 95% CI, 1.01– 1.63), a shift toward unfavorable outcome in modified Rankin Scale (adjusted common OR, 1.58; 95% CI, 1.32–1.91) and a higher risk of death at day 90 (adjusted OR, 1.63; 95% CI, 1.25–2.11). Tranexamic acid reduced the risk of hematoma expansion in the overall patients with ICH (adjusted OR, 0.76; 95% CI, 0.62–0.93) and antiplatelet subgroup (adjusted OR, 0.61; 95% CI, 0.41–0.91) with no significant interaction between pre-ICH antiplatelet therapy and tranexamic acid (P interaction=0.248). CONCLUSIONS: Antiplatelet therapy is independently associated with hematoma expansion and unfavorable functional out-come. Tranexamic acid reduced hematoma expansion regardless of prior antiplatelet therapy use. REGISTRATION: URL: https://www.isrctn.com; Unique identifier: ISRCTN93732214.
Original language | English |
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Article number | e019130 |
Journal | Journal of the American Heart Association |
Volume | 10 |
Issue number | 5 |
Pages (from-to) | 1-12 |
Number of pages | 12 |
ISSN | 2047-9980 |
DOIs | |
Publication status | Published - 2021 |
Bibliographical note
Funding Information:
This work was supported by the National Institute for Health Research Health Technology Assessment Programme (11_129_109) and the Swiss Heart Foundation.
Publisher Copyright:
© 2021 The Authors.
- Antiplatelet, Cerebral hemorrhage, Hematoma expansion, Randomized controlled trial, Tranexamic acid
Research areas
ID: 281228409