Ching-Jen Chen1, Dale Ding2, Thomas J Buell2, Fernando D Testai2, Sebastian Koch2, Daniel Woo2, Bradford B Worrall2. 1. From the Departments of Neurological Surgery (C.-J.C., T.J.B.) and Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurosurgery (D.D.), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (F.D.T.), University of Illinois, Chicago; Department of Neurology (S.K.), University of Miami Miller School of Medicine, FL; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH. chenjared@gmail.com. 2. From the Departments of Neurological Surgery (C.-J.C., T.J.B.) and Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurosurgery (D.D.), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (F.D.T.), University of Illinois, Chicago; Department of Neurology (S.K.), University of Miami Miller School of Medicine, FL; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH.
Abstract
OBJECTIVE: To compare the functional outcomes and health-related quality of life metrics of restarting vs not restarting antiplatelet therapy (APT) in patients presenting with intracerebral hemorrhage (ICH) in the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) study. METHODS: Adult patients aged 18 years and older who were on APT before ICH and were alive at hospital discharge were included. Patients were dichotomized based on whether or not APT was restarted after hospital discharge. The primary outcome was a modified Rankin Scale score of 0-2 at 90 days. Secondary outcomes were excellent outcome (modified Rankin Scale score 0-1), mortality, Barthel Index, and health status (EuroQol-5 dimensions [EQ-5D] and EQ-5D visual analog scale scores) at 90 days. RESULTS: The APT and no APT cohorts comprised 127 and 732 patients, respectively. Restarting APT was associated with lower rates of good functional outcome (36.5% vs 40.8%; p = 0.021) and lower Barthel Index scores at 90 days (p = 0.041). The 2 cohorts were then matched in a 1:1 ratio, and the matched cohorts each comprised 107 patients. No difference in primary outcome was observed between restarting vs not restarting APT (35.5% vs 43.9%; p = 0.105). There were also no differences between the secondary outcomes of the 2 cohorts. CONCLUSION: Restarting APT in patients with ICH of mild to moderate severity after acute hospitalization is not associated with worse functional outcomes or health-related quality of life at 90 days. In patients with significant cardiovascular risk factors who experience an ICH, restarting APT remains the decision of the treating practitioner.
OBJECTIVE: To compare the functional outcomes and health-related quality of life metrics of restarting vs not restarting antiplatelet therapy (APT) in patients presenting with intracerebral hemorrhage (ICH) in the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) study. METHODS: Adult patients aged 18 years and older who were on APT before ICH and were alive at hospital discharge were included. Patients were dichotomized based on whether or not APT was restarted after hospital discharge. The primary outcome was a modified Rankin Scale score of 0-2 at 90 days. Secondary outcomes were excellent outcome (modified Rankin Scale score 0-1), mortality, Barthel Index, and health status (EuroQol-5 dimensions [EQ-5D] and EQ-5D visual analog scale scores) at 90 days. RESULTS: The APT and no APT cohorts comprised 127 and 732 patients, respectively. Restarting APT was associated with lower rates of good functional outcome (36.5% vs 40.8%; p = 0.021) and lower Barthel Index scores at 90 days (p = 0.041). The 2 cohorts were then matched in a 1:1 ratio, and the matched cohorts each comprised 107 patients. No difference in primary outcome was observed between restarting vs not restarting APT (35.5% vs 43.9%; p = 0.105). There were also no differences between the secondary outcomes of the 2 cohorts. CONCLUSION: Restarting APT in patients with ICH of mild to moderate severity after acute hospitalization is not associated with worse functional outcomes or health-related quality of life at 90 days. In patients with significant cardiovascular risk factors who experience an ICH, restarting APT remains the decision of the treating practitioner.
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