Shannon M Fernando1,2, Garrick Mok2, Bram Rochwerg3,4, Shane W English1,5,6, Kednapa Thavorn5,6, Victoria A McCredie7,8, Dar Dowlatshahi5,6,9, Jeffrey J Perry2,5,6, Eelco F M Wijdicks10, Peter M Reardon1,2, Peter Tanuseputro5,6,11, Kwadwo Kyeremanteng1,6,11. 1. Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada. 2. Department of Emergency Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada. 3. Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 4. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. 5. School of Epidemiology and Public Health, 6363University of Ottawa, Ottawa, Ontario, Canada. 6. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 7. Interdepartmental Division of Critical Care Medicine, 7938University of Toronto, Toronto, Ontario, Canada. 8. Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. 9. Division of Neurology, Department of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada. 10. Division of Neurocritical Care and Hospital Neurology, Department of Neurology, 6915Mayo Clinic, Rochester, MN, USA. 11. Division of Palliative Care, Department of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada.
Abstract
INTRODUCTION: Patients with intracranial hemorrhage (including intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic hemorrhage) are commonly admitted to the intensive care unit (ICU). Although indications for oral antiplatelet agents are increasing, the impact of preadmission use on outcomes in patients with intracranial hemorrhage admitted to the ICU is unknown. We sought to evaluate the association between preadmission oral antiplatelet use, in-hospital mortality, resource utilization, and costs among ICU patients with intracranial hemorrhage. METHODS: We retrospectively analyzed a prospectively collected registry (2011-2016) and included consecutive adult patients from 2 hospitals admitted to ICU with intracranial hemorrhage. Patients were categorized on the basis of preadmission oral antiplatelet use. We excluded patients with preadmission anticoagulant use. The primary outcome was in-hospital mortality and was analyzed using a multivariable logistic regression model. Contributors to total hospital cost were analyzed using a generalized linear model with log link and gamma distribution. RESULTS: Of 720 included patients with intracranial hemorrhage, 107 (14.9%) had been using an oral antiplatelet agent at the time of ICU admission. Oral antiplatelet use was not associated with in-hospital mortality (adjusted odds ratio: 1.31 [95% confidence interval [CI]: 0.93-2.22]). Evaluation of total costs also revealed no association with oral antiplatelet use (adjusted ratio of means [aROM]: 0.92 [95% CI: 0.82-1.02, P = .10]). Total cost among patients with intracranial hemorrhage was driven by illness severity (aROM: 1.96 [95% CI: 1.94-1.98], P < .001), increasing ICU length of stay (aROM: 1.05 [95% CI: 1.05-1.06], P < .001), and use of invasive mechanical ventilation (aROM: 1.76 [95% CI: 1.68-1.86], P < .001). CONCLUSIONS: Among ICU patients admitted with intracranial hemorrhage, preadmission oral antiplatelet use was not associated with increased in-hospital mortality or hospital costs. These findings have important prognostic implications for clinicians who care for patients with intracranial hemorrhage.
INTRODUCTION: Patients with intracranial hemorrhage (including intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic hemorrhage) are commonly admitted to the intensive care unit (ICU). Although indications for oral antiplatelet agents are increasing, the impact of preadmission use on outcomes in patients with intracranial hemorrhage admitted to the ICU is unknown. We sought to evaluate the association between preadmission oral antiplatelet use, in-hospital mortality, resource utilization, and costs among ICU patients with intracranial hemorrhage. METHODS: We retrospectively analyzed a prospectively collected registry (2011-2016) and included consecutive adult patients from 2 hospitals admitted to ICU with intracranial hemorrhage. Patients were categorized on the basis of preadmission oral antiplatelet use. We excluded patients with preadmission anticoagulant use. The primary outcome was in-hospital mortality and was analyzed using a multivariable logistic regression model. Contributors to total hospital cost were analyzed using a generalized linear model with log link and gamma distribution. RESULTS: Of 720 included patients with intracranial hemorrhage, 107 (14.9%) had been using an oral antiplatelet agent at the time of ICU admission. Oral antiplatelet use was not associated with in-hospital mortality (adjusted odds ratio: 1.31 [95% confidence interval [CI]: 0.93-2.22]). Evaluation of total costs also revealed no association with oral antiplatelet use (adjusted ratio of means [aROM]: 0.92 [95% CI: 0.82-1.02, P = .10]). Total cost among patients with intracranial hemorrhage was driven by illness severity (aROM: 1.96 [95% CI: 1.94-1.98], P < .001), increasing ICU length of stay (aROM: 1.05 [95% CI: 1.05-1.06], P < .001), and use of invasive mechanical ventilation (aROM: 1.76 [95% CI: 1.68-1.86], P < .001). CONCLUSIONS: Among ICU patients admitted with intracranial hemorrhage, preadmission oral antiplatelet use was not associated with increased in-hospital mortality or hospital costs. These findings have important prognostic implications for clinicians who care for patients with intracranial hemorrhage.
Entities:
Keywords:
antiplatelet; health economics; intensive care unit; intracerebral hemorrhage; intracranial hemorrhage; subarachnoid hemorrhage; traumatic brain injury
Authors: François Mathieu; Armaan K Malhotra; Jerry C Ku; Frederick A Zeiler; Jefferson R Wilson; Farhad Pirouzmand; Damon C Scales Journal: Neurotrauma Rep Date: 2022-08-10