Anil Can1, Robert F Rudy1, Victor M Castro1, Sheng Yu1, Dmitriy Dligach1, Sean Finan1, Vivian Gainer1, Nancy A Shadick1, Guergana Savova1, Shawn Murphy1, Tianxi Cai1, Scott T Weiss1, Rose Du2. 1. From the Department of Neurosurgery (A.C., R.F.R., R.D.), Brigham and Women's Hospital, Harvard Medical School; Research Information Systems and Computing (V.M.C., V.G., S.M.); Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R.D.), Brigham and Women's Hospital, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Boston Children's Hospital Informatics Program (D.D., S.F., G.S.), MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard T.H. Chan School of Public Health, Boston, MA. 2. From the Department of Neurosurgery (A.C., R.F.R., R.D.), Brigham and Women's Hospital, Harvard Medical School; Research Information Systems and Computing (V.M.C., V.G., S.M.); Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R.D.), Brigham and Women's Hospital, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Boston Children's Hospital Informatics Program (D.D., S.F., G.S.), MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard T.H. Chan School of Public Health, Boston, MA. rdu@bwh.harvard.edu.
Abstract
OBJECTIVE: To determine the association between ruptured saccular aneurysms and aspirin use/aspirin dose. METHODS: Four thousand seven hundred one patients who were diagnosed at the Massachusetts General Hospital and Brigham and Women's Hospital between 1990 and 2016 with 6,411 unruptured and ruptured saccular intracranial aneurysms were evaluated. Univariable and multivariable logistic regression analyses were performed to determine the association between aneurysmal subarachnoid hemorrhage and aspirin use, including aspirin dose. Inverse probability weighting using propensity scores was used to adjust for potential differences in baseline characteristics between cases and controls. Additional analyses were performed to examine the association of aspirin use and rerupture before treatment. RESULTS: In multivariate analysis with propensity score weighting, aspirin use (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.45-0.80) was significantly associated with decreased risk of ruptured intracranial aneurysms. There was a significant inverse dose-response relationship between aspirin dose and aneurysmal subarachnoid hemorrhage (OR 0.65, 95% CI 0.53-0.81). In contrast, there was a significant association between aspirin use and increased risk of rerupture before treatment (OR 8.15, 95% CI 2.22-30.0). CONCLUSIONS: In this large case-control study, aspirin therapy at diagnosis was associated with a significantly decreased risk of subarachnoid hemorrhage, with an inverse dose-response relationship among aspirin users. However, once rupture has occurred, aspirin is associated with an increased risk of rerupture before treatment.
OBJECTIVE: To determine the association between ruptured saccular aneurysms and aspirin use/aspirin dose. METHODS: Four thousand seven hundred one patients who were diagnosed at the Massachusetts General Hospital and Brigham and Women's Hospital between 1990 and 2016 with 6,411 unruptured and ruptured saccular intracranial aneurysms were evaluated. Univariable and multivariable logistic regression analyses were performed to determine the association between aneurysmal subarachnoid hemorrhage and aspirin use, including aspirin dose. Inverse probability weighting using propensity scores was used to adjust for potential differences in baseline characteristics between cases and controls. Additional analyses were performed to examine the association of aspirin use and rerupture before treatment. RESULTS: In multivariate analysis with propensity score weighting, aspirin use (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.45-0.80) was significantly associated with decreased risk of ruptured intracranial aneurysms. There was a significant inverse dose-response relationship between aspirin dose and aneurysmal subarachnoid hemorrhage (OR 0.65, 95% CI 0.53-0.81). In contrast, there was a significant association between aspirin use and increased risk of rerupture before treatment (OR 8.15, 95% CI 2.22-30.0). CONCLUSIONS: In this large case-control study, aspirin therapy at diagnosis was associated with a significantly decreased risk of subarachnoid hemorrhage, with an inverse dose-response relationship among aspirin users. However, once rupture has occurred, aspirin is associated with an increased risk of rerupture before treatment.
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