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Multicenter Study
. 2022 Jun;17(5):545-552.
doi: 10.1177/17474930211035647. Epub 2021 Jul 29.

Prehemorrhage antiplatelet use in aneurysmal subarachnoid hemorrhage and impact on clinical outcome

Martina Sebök  1   2 , Isabel C Hostettler  3   4 , Emanuela Keller  2   5 , Ilari M Rautalin  6 , Bert A Coert  7 , William P Vandertop  7 , René Post  7 , Ali Sardeha  7 , Maud A Tjerkstra  7 , Luca Regli  1   2 , Dagmar Verbaan  7 , Menno R Germans  1   2
Affiliations
Multicenter Study

Prehemorrhage antiplatelet use in aneurysmal subarachnoid hemorrhage and impact on clinical outcome

Martina Sebök et al. Int J Stroke. 2022 Jun.

Abstract

Background: Literature is inconclusive regarding the association between antiplatelet agents use and outcome after aneurysmal subarachnoid hemorrhage.

Aims: To investigate the association between clinical outcome and prehemorrhage use in aneurysmal subarachnoid hemorrhage patients as well as the impact of thrombocyte transfusion on rebleed and clinical outcome.

Methods: Data were collected from prospective databases of two European tertiary reference centers for aneurysmal subarachnoid hemorrhage patients. Patients were divided into "antiplatelet-user" and "non-user" according to the use of acetylsalicylic acid prior to the hemorrhage. Primary outcome was poor clinical outcome at six months (Glasgow Outcome Scale score 1-3). Secondary outcomes were in-hospital mortality and impact of thrombocyte transfusion.

Results: Of the 1033 patients, 161 (15.6%) were antiplatelet users. The antiplatelet users were older with higher incidence of cardiovascular risk factors. Antiplatelet use was associated with poor outcome and in-hospital mortality. After correction for age, sex, World Federation of Neurosurgical Societies score, infarction and heart disorder, pre-hemorrhage acetylsalicylic acid use was only associated with poor clinical outcome at six months (adjusted OR 1.80, 95% CI 1.08-3.02). Thrombocyte transfusion was not associated with a reduction in rebleed or poor clinical outcome.

Conclusion: In this multicenter study, the prehemorrhage acetylsalicylic acid use in aneurysmal subarachnoid hemorrhage patients was independently associated with poor clinical outcome at six months. Thrombocyte transfusion was not associated with the rebleed rate or poor clinical outcome at six months.

Keywords: Aneurysmal subarachnoid hemorrhage; acetylsalicylic acid; antiplatelet agent; mortality; outcome; rebleed; thrombocyte transfusion.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Study flow chart. Between January 2005 and December 2016, 791 patients with aSAH and prehemorrhage antiplatelet use were treated at the Department of Neurosurgery of the University Hospital Zurich and 332 patients between December 2011 and December 2015 at the Department of Neurosurgery of the Academic University Medical Center Amsterdam. Cumulative, 1123 patients with aSAH and prehemorrhage acetylsalicylic acid use were available for inclusion in this prospective cohort study. Ninety patients with missing six-month clinical outcome data were excluded from the study. In the final analysis, 1033 patients were included. aSAH: aneurysmal subarachnoid hemorrhage.
See this image and copyright information in PMC

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