Marta Pasquini1, Andreas Charidimou1, Charlotte J J van Asch1, Merih I Baharoglu1, Neshika Samarasekera1, David J Werring1, Catharina J M Klijn1, Yvo B Roos1, Rustam Al-Shahi Salman1, Charlotte Cordonnier2. 1. From the Department of Neurology, Université Lille Nord de France, UDSL, EA 1046, Lille, France (M.P., C.C.); Department of Neurology, Université Catholique de Lille, Lille, France (M.P.); Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom (A.C., D.J.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (C.J.J.v.A., C.J.M.K.); Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.I.B., Y.B.R.); and Division of Clinical Neurosciences, Center for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom (N.S., R.A.-S.S.). 2. From the Department of Neurology, Université Lille Nord de France, UDSL, EA 1046, Lille, France (M.P., C.C.); Department of Neurology, Université Catholique de Lille, Lille, France (M.P.); Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom (A.C., D.J.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (C.J.J.v.A., C.J.M.K.); Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.I.B., Y.B.R.); and Division of Clinical Neurosciences, Center for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom (N.S., R.A.-S.S.). charlotte.cordonnier@chru-lille.fr.
Abstract
BACKGROUND AND PURPOSE: Whether intracerebral hemorrhage (ICH) survivors should restart antithrombotic drugs is unknown. We analyzed the frequency of restarting antithrombotic drugs in ICH survivors who had taken prophylactic antithrombotic drugs in atrial fibrillation or after thromboembolic disease in 5 cohorts and explored factors associated with doing so. METHODS: We compared the characteristics and proportions of patients taking antithrombotic drugs at ICH onset and discharge in 4 hospital-based cohorts (Lille, France, n=542; Utrecht, The Netherlands, n=389; multicenter Clinical Relevance of Microbleeds in Stroke-2 (CROMIS-2) ICH, United Kingdom, n=667; and Amsterdam, The Netherlands, n=403) and 1 community-based study (Lothian, Scotland, n=137), using bivariate analyses. We sought characteristics associated with restarting using bivariate and multivariable logistic regression analyses. RESULTS: A total of 942 (44%) patients with ICH took antithrombotic drugs at hospital admission (no difference between cohorts). Antithrombotic drugs were restarted in 96 (20%) of the 469 survivors who had taken antithrombotic drugs for secondary prevention or atrial fibrillation, but this proportion differed when stratified by the cohort of origin (Lille, 18%; Utrecht, 45%; Lothian, 15%; CROMIS-2 ICH, 11%; Amsterdam, 20%; P<0.001) and by type of antithrombotic drug pre-ICH (14% in patients with previous antiplatelet drugs versus 26% in patients with previous vitamin K antagonists and 41% in patients with both drugs; P<0.001). We did not find other consistent, independent associations with restarting antithrombotic drugs. CONCLUSIONS: The variation in clinical practice and lack of consistent associations with restarting antithrombotic drugs after ICH reflect current knowledge and support the need for randomized controlled trials to resolve this dilemma.
BACKGROUND AND PURPOSE: Whether intracerebral hemorrhage (ICH) survivors should restart antithrombotic drugs is unknown. We analyzed the frequency of restarting antithrombotic drugs in ICH survivors who had taken prophylactic antithrombotic drugs in atrial fibrillation or after thromboembolic disease in 5 cohorts and explored factors associated with doing so. METHODS: We compared the characteristics and proportions of patients taking antithrombotic drugs at ICH onset and discharge in 4 hospital-based cohorts (Lille, France, n=542; Utrecht, The Netherlands, n=389; multicenter Clinical Relevance of Microbleeds in Stroke-2 (CROMIS-2) ICH, United Kingdom, n=667; and Amsterdam, The Netherlands, n=403) and 1 community-based study (Lothian, Scotland, n=137), using bivariate analyses. We sought characteristics associated with restarting using bivariate and multivariable logistic regression analyses. RESULTS: A total of 942 (44%) patients with ICH took antithrombotic drugs at hospital admission (no difference between cohorts). Antithrombotic drugs were restarted in 96 (20%) of the 469 survivors who had taken antithrombotic drugs for secondary prevention or atrial fibrillation, but this proportion differed when stratified by the cohort of origin (Lille, 18%; Utrecht, 45%; Lothian, 15%; CROMIS-2 ICH, 11%; Amsterdam, 20%; P<0.001) and by type of antithrombotic drug pre-ICH (14% in patients with previous antiplatelet drugs versus 26% in patients with previous vitamin K antagonists and 41% in patients with both drugs; P<0.001). We did not find other consistent, independent associations with restarting antithrombotic drugs. CONCLUSIONS: The variation in clinical practice and lack of consistent associations with restarting antithrombotic drugs after ICH reflect current knowledge and support the need for randomized controlled trials to resolve this dilemma.
Authors: Jochen A Sembill; Claudia Y Wieser; Maximilian I Sprügel; Stefan T Gerner; Antje Giede-Jeppe; Caroline Reindl; Ilker Y Eyüpoglu; Philip Hoelter; Hannes Lücking; Joji B Kuramatsu; Hagen B Huttner Journal: J Neurol Date: 2018-08-20 Impact factor: 4.849
Authors: Eleni Korompoki; Filippos T Filippidis; Peter B Nielsen; Angela Del Giudice; Gregory Y H Lip; Joji B Kuramatsu; Hagen B Huttner; Jiming Fang; Sam Schulman; Joan Martí-Fàbregas; Celine S Gathier; Anand Viswanathan; Alessandro Biffi; Daniela Poli; Christian Weimar; Uwe Malzahn; Peter Heuschmann; Roland Veltkamp Journal: Neurology Date: 2017-07-19 Impact factor: 9.910
Authors: Narlin B Beaty; Jessica K Campos; Geoffrey P Colby; Li-Mei Lin; Matthew T Bender; Risheng Xu; Alexander L Coon Journal: Interv Neurol Date: 2018-02-03