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The Clinical Impact of Anticoagulants and Platelet Aggregation Inhibitors on Spontaneous Intracerebral Hemorrhage

Friday, May 3, 2024

    Presenting Author(s)

  • Varunil N. Shah, BS (he/him/his)

    Medical Student
    Case Western Reserve University School of Medicine
    Cleveland, OH, US

    • Co-Author(s)

  • RD

    Ravi Dhamija, n/a

    Medical Student
    Case Western Reserve University, School of Medicine, United States

  • DK

    David Kaelber, MD

    Professor of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences
    The MetroHealth System, Case Western Reserve University School of Medicine, United States

  • MK

    Michael L. Kelly, M.D.

    Department Chair of Neurosurgery
    The MetroHealth System
    Cleveland, Ohio, United States

  • DR

    Deven Reddy, MD

    Assistant Professor, Case Western Reserve University School of Medicine
    Department of Neurosurgery, The MetroHealth System
    Solon, Ohio, United States

Introduction: Nontraumatic spontaneous intracerebral hemorrhage (sICH) is bleeding within the brain parenchyma and can be associated with hypertensive damage to blood vessels, amyloid angiopathy, cancer, thrombosis, and other conditions. This study aims to determine the clinical impact of platelet aggregation inhibitor (PAI) and anticoagulant (AC) medication on patients with sICH.

Methods: This was a retrospective study that utilized the TriNetX Analytics network. Using ICD-10 codes, three groups of sICH patients were created: patients on AC but not on PAI (sICH-AC), patients on PAI but not on AC (sICH-PAI), and patients on neither PAI nor AC (sICH-N). Patients in these groups had this condition met one week prior to their sICH. One-to-one propensity matching was completed based on demographic, cardiological, neurological, and endocrine conditions. Odds ratios with 95% confidence intervals were calculated. The primary outcome was mortality at 30 days and 90 days.

Results: The network consisted of 102,396,428 patients. There were 175,326 patients in the sICH-N group, 26,318 patients in the sICH-AC group, and 9,583 in the sICH-PAI group. The odds ratio for mortality between sICH-AC group and sICH-N group was 1.255 (1.199–1.313, p< 0.0001) at 30 days and 1.352 (1.296–1.410, p< 0.0001) at 90 days. Additionally, the odds ratio between the sICH-PAI group and sICH-N group was 0.799 (0.746–0.856, p< 0.0001) for mortality at 30 days and 0.82 (0.769–0.874, p< 0.0001) at 90 days. After comparing the sICH-PAI group and sICH-AC group, patients in the sICH-PAI group had a odds ratio for mortality of 0.673 (0.628–0.721, p< 0.0001) at 30 days and 0.638 (0.599–0.680, p< 0.0001) at 90 days.

Conclusion : According to the findings, patients on anticoagulants are at a significantly higher risk for mortality following a sICH compared to patients on PAIs and patients not on PAI or AC. In addition, patients on PAIs fare better suggesting a potential protective effect.