Pre-ICH warfarin use, not antiplatelets, increased case fatality in spontaneous ICH patients

Authors

  • Y.-W. Chen,

    1. Department of Neurology, Landseed Hospital, Taoyuan;, Taiwan
    2. Stroke Center and Department of Neurology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei;, Taiwan
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  • S.-C. Tang,

    1. Stroke Center and Department of Neurology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei;, Taiwan
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  • L.-K. Tsai,

    1. Stroke Center and Department of Neurology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei;, Taiwan
    2. Department of Neurology, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin;, Taiwan
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  • S.-J. Yeh,

    1. Department of Neurology, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin;, Taiwan
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  • H.-Y. Chiou,

    1. School of Public Health, Taipei Medical University, Taipei;, Taiwan
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  • P.-K. Yip,

    1. Department of Neurology, Cardinal Tien Hospital, New Taipei City;, Taiwan
    2. School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
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  • J.-S. Jeng

    Corresponding author
    1. Stroke Center and Department of Neurology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei;, Taiwan
    • Department of Neurology, Landseed Hospital, Taoyuan;, Taiwan
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Correspondence: J.-S. Jeng, MD, PhD, Department of Neurology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, 100, Taipei, Taiwan (tel.: +886 2 23123456 65338; fax: +886 2 23418395; e-mail: jsjeng@ntu.edu.tw).

Abstract

Background and purpose

Anticoagulant and antiplatelets for prevention of ischaemic stroke and cardiovascular diseases may increase the risk of intracerebral hemorrhage (ICH). This study aimed to investigate the influence of pre-ICH use of anticoagulant and antiplatelets on ICH patients.

Methods

Consecutive patients with acute spontaneous ICH registered in a single-center stroke registry during 2001 to 2010 were analyzed and categorized according to their pre-ICH use of warfarin (Group I), antiplatelets (Group II), or neither (Group III). Survival analysis and the Cox proportional hazard model were used to compare between the three groups and the predictors.

Results

Of 2021 ICH patients (male, 63.3%; mean age, 62.6 ± 14.4 years) included, there were 94 (4.7%) in Group I, 232 (11.4%) in Group II, and 1695 (83.9%) in Group III. Warfarin users had larger hematoma volume, more intraventricular extension, higher frequencies of lobar ICH, and higher case fatality than non-warfarin users (Groups II and III). The Cox proportional hazard model showed increased 6-month case fatality in pre-ICH warfarin users (adjusted hazard ratio 2.75, 95% confidence interval 2.04–3.72, < 0.001), but not in pre-ICH antiplatelet users (adjusted hazard ratio 0.95, 95% confidence interval 0.72–1.26).

Conclusions

Intracerebral hemorrhage patients with prior warfarin use, but not antiplatelet use, had significantly higher case fatality at 6 months.

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