Kay-Cheong Teo1, Gary K K Lau1, Ryan H Y Mak1, Ho-Yan Leung1, Richard S K Chang1, Man-Yu Tse1, Raymand Lee2, Gilberto K K Leung3, Shu-Leong Ho1, Raymond T F Cheung4, David C W Siu4, Koon-Ho Chan5. 1. University Department of Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong. 2. Department of Diagnostic Radiology, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong. 3. Division of Neurosurgery, Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong. 4. University Department of Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong; Research Center of Heart, Brain, Hormones, and Healthy Aging, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong. 5. University Department of Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong; Research Center of Heart, Brain, Hormones, and Healthy Aging, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong. Electronic address: koonho@hku.hk.
Abstract
BACKGROUND: Antiplatelet resumption in patients who developed intracerebral hemorrhage (ICH) while on antiplatelet therapy (antiplatelet-related ICH) represents an important medical dilemma. We aimed to study the long-term cardiovascular outcomes of antiplatelet-related ICH survivors, and the risk of recurrent ICH with antiplatelet resumption. METHODS: This was an observational study of 109 antiplatelet-related ICH survivors. The clinical end points were recurrent ICH, ischemic vascular events, and vascular death (fatal ICH or ischemic vascular events). Predictors of recurrent ICH and vascular death were derived using a multivariable Cox regression model. RESULTS: The median duration of follow-up was 3.5 years (interquartile range, 1.6-5.8 years). Ischemic vascular events were more common than recurrent ICHs (6.8 per 100 patient-years vs. 2.6 per 100 patient-years; P = 0.028). Antiplatelet use was not associated with an elevated risk of recurrent ICH (hazard ratio [HR], 1.11, 95% confidence interval [CI], 0.27-4.62). A mean follow-up systolic blood pressure of >140 mmHg increased the risk of both recurrent ICH (HR, 4.28; 95% CI, 1.01-18.11) and vascular death (HR, 11.14; 95% CI, 2.72-45.62). Cerebral amyloid angiopathy (CAA) was an independent predictor for recurrent ICH (HR, 24.34; 95% CI, 2.80-211.47). CONCLUSIONS: Antiplatelet resumption after antiplatelet-related ICH did not appear to carry a clinically significant risk of recurrent ICH, whereas inadequate blood pressure control and CAA contributed to a more robust risk. Antiplatelet resumption should be considered, especially in survivors with adequate blood pressure control and without CAA.
BACKGROUND: Antiplatelet resumption in patients who developed intracerebral hemorrhage (ICH) while on antiplatelet therapy (antiplatelet-related ICH) represents an important medical dilemma. We aimed to study the long-term cardiovascular outcomes of antiplatelet-related ICH survivors, and the risk of recurrent ICH with antiplatelet resumption. METHODS: This was an observational study of 109 antiplatelet-related ICH survivors. The clinical end points were recurrent ICH, ischemic vascular events, and vascular death (fatal ICH or ischemic vascular events). Predictors of recurrent ICH and vascular death were derived using a multivariable Cox regression model. RESULTS: The median duration of follow-up was 3.5 years (interquartile range, 1.6-5.8 years). Ischemic vascular events were more common than recurrent ICHs (6.8 per 100 patient-years vs. 2.6 per 100 patient-years; P = 0.028). Antiplatelet use was not associated with an elevated risk of recurrent ICH (hazard ratio [HR], 1.11, 95% confidence interval [CI], 0.27-4.62). A mean follow-up systolic blood pressure of >140 mmHg increased the risk of both recurrent ICH (HR, 4.28; 95% CI, 1.01-18.11) and vascular death (HR, 11.14; 95% CI, 2.72-45.62). Cerebral amyloid angiopathy (CAA) was an independent predictor for recurrent ICH (HR, 24.34; 95% CI, 2.80-211.47). CONCLUSIONS: Antiplatelet resumption after antiplatelet-related ICH did not appear to carry a clinically significant risk of recurrent ICH, whereas inadequate blood pressure control and CAA contributed to a more robust risk. Antiplatelet resumption should be considered, especially in survivors with adequate blood pressure control and without CAA.
Authors: Victor J Del Brutto; Seemant Chaturvedi; Hans-Christoph Diener; Jose G Romano; Ralph L Sacco Journal: J Am Coll Cardiol Date: 2019-08-13 Impact factor: 24.094
Authors: Rustam Al-Shahi Salman; Martin S Dennis; Gordon D Murray; Karen Innes; Jonathan Drever; Lynn Dinsmore; Carol Williams; Philip M White; William N Whiteley; Peter A G Sandercock; Cathie L M Sudlow; David E Newby; Nikola Sprigg; David J Werring Journal: Trials Date: 2018-03-05 Impact factor: 2.279
Authors: Rustam Al-Shahi Salman; Gordon D Murray; Martin S Dennis; David E Newby; Peter A G Sandercock; Nikola Sprigg; Cathie L M Sudlow; David J Werring; Philip M White; William N Whiteley Journal: Trials Date: 2019-03-25 Impact factor: 2.279
Authors: Juan Pablo Castello; Kay-Cheong Teo; Jessica R Abramson; Sophia Keins; Courtney E Takahashi; Ian Y H Leung; William C Y Leung; Yujie Wang; Christina Kourkoulis; Evangelos Pavlos Myserlis; Andrew D Warren; Jonathan Henry; Koon-Ho Chan; Raymond T F Cheung; Shu-Leong Ho; M Edip Gurol; Anand Viswanathan; Steven M Greenberg; Christopher D Anderson; Kui-Kai Lau; Jonathan Rosand; Alessandro Biffi Journal: J Am Heart Assoc Date: 2022-03-05 Impact factor: 6.106