Abstract
Background
Problems that the risk of using antiplatelet/anticoagulant may overwhelm its benefits have been raised. We analyzed patients with spontaneous intracerebral hemorrhage who had received antiplatelet/anticoagulant therapy.
Method
A consecutive series of patients with spontaneous intracerebral hemorrhage who underwent brain computed tomographic (CT) scans within 48 h from attack. We analyzed the clinical manifestations and radiologic findings of the patients according to antiplatelet/anticoagulant therapy: Antiplatelet group, Anticoagulant group, and None group.
Results
A total of 338 patients were included in the study. The initial volume of hematoma was 46.8 ml in the Anticoagulant group, and 24.1 ml in the None group. There were significant differences among the groups in terms of intraventricular hemorrhage (Antiplatelet group: 45.6 %, Anticoagulant group: 20 %, None: 26.4 %, p = 0.008), and the proportion of hydrocephalus in the Antiplatelet group was higher than in another group (p = 0.017). Also, herniation and expansion of spontaneous intracerebral hemorrhage had significant differences among the groups. The prognoses of the None group were the best among the groups. There was also significant difference in the mortality among the groups.
Conclusions
In comparison with the None group, the spontaneous intracerebral hemorrhages of the Antiplatelet/Anticoagulant group were a little more extensive and they had more intraventricular hemorrhage, hydrocephalus, herniation, and expansion of spontaneous intracerebral hemorrhage that would come to poor prognosis. Therefore, antiplatelets and anticoagulants should be used under strict indications.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00701-014-2080-2/MediaObjects/701_2014_2080_Fig1_HTML.gif)
Similar content being viewed by others
References
Barras CD, Tress BM, Christensen S, MacGregor L, Collins M, Desmond PM, Skolnick BE, Mayer SA, Broderick JP, Diringer MN, Steiner T, Davis SM (2009) Density and shape as CT predictors of intracerebral hemorrhage growth. Stroke 40:1325–1331
Bhatt DL, Stone GW, Mahaffey KW, Gibson CM, Steg PG, Hamm CW, Price MJ, Leonardi S, Gallup D, Bramucci E, Radke PW, Widimsky P, Tousek F, Tauth J, Spriggs D, McLaurin BT, Angiolillo DJ, Genereux P, Liu T, Prats J, Todd M, Skerjanec S, White HD, Harrington RA (2013) Effect of platelet inhibition with cangrelor during PCI on ischemic events. N Engl J Med 368:1303–1313
Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G (1993) Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 24:987–993
Broderick JP, Diringer MN, Hill MD, Brun NC, Mayer SA, Steiner T, Skolnick BE, Davis SM (2007) Determinants of intracerebral hemorrhage growth: an exploratory analysis. Stroke 38:1072–1075
Collins R, Peto R, Hennekens C, Doll R, Bubes V, Buring J, Dushkesas R, Gaziano M, Brennam P, Meade T, Rudnicka A, Hansson L, Warnold I, Zanchetti A, Avanzini F, Roncaglioni MC, Tognoni G, Chown M, Gaziano M, Hennekens C, Baigent C, Barton I, Baxter A, Bhala N, Blackwell L, Boreham J, Bowman L, Buck G, Collins R, Emberson J, Godwin J, Halls H, Holland L, Kearney P, Peto R, Reith C, Wilson K, Baigent C, Blackwell L, Patrono C, Collabora AT (2009) Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 373:1849–1860
Cucchiara B, Messe S, Sansing L, Kasner S, Lyden P (2008) Hematoma growth in oral anticoagulant related intracerebral hemorrhage. Stroke 39:2993–2996
De Berardis G, Lucisano G, D’Ettorre A, Pellegrini F, Lepore V, Tognoni G, Nicolucci A (2012) Association of Aspirin Use With Major Bleeding in Patients With and Without Diabetes. Jama-Journal of the American Medical Association 307:2286–2294
Delgado P, Alvarez-Sabin J, Abilleira S, Santamarina E, Purroy F, Arenillas JF, Molina CA, Fernandez-Cadenas I, Rosell A, Montaner J (2006) Plasma d-dimer predicts poor outcome after acute intracerebral hemorrhage. Neurology 67:94–98
Diringer MN, Edwards DF, Zazulia AR (1998) Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage. Stroke 29:1352–1357
Dowlatshahi D, Demchuk AM, Flaherty ML, Ali M, Lyden PL, Smith EE (2011) Defining hematoma expansion in intracerebral hemorrhage: relationship with patient outcomes. Neurology 76:1238–1244
Elliott J, Smith M (2010) The acute management of intracerebral hemorrhage: a clinical review. Anesth Analg 110:1419–1427
Flaherty ML, Tao H, Haverbusch M, Sekar P, Kleindorfer D, Kissela B, Khatri P, Stettler B, Adeoye O, Moomaw CJ, Broderick JP, Woo D (2008) Warfarin use leads to larger intracerebral hematomas. Neurology 71:1084–1089
Flibotte JJ, Hagan N, O’Donnell J, Greenberg SM, Rosand J (2004) Warfarin, hematoma expansion, and outcome of intracerebral hemorrhage. Neurology 63:1059–1064
Hallevi H, Albright KC, Aronowski J, Barreto AD, Martin-Schild S, Khaja AM, Gonzales NR, Illoh K, Noser EA, Grotta JC (2008) Intraventricular hemorrhage: Anatomic relationships and clinical implications. Neurology 70:848–852
Hallevi H, Dar NS, Barreto AD, Morales MM, Martin-Schild S, Abraham AT, Walker KC, Gonzales NR, Illoh K, Grotta JC, Savitz SI (2009) The IVH score: a novel tool for estimating intraventricular hemorrhage volume: clinical and research implications. Crit Care Med 37(969–974):e961
Hanger HC, Fletcher VJ, Wilkinson TJ, Brown AJ, Frampton CM, Sainsbury R (2008) Effect of aspirin and warfarin on early survival after intracerebral haemorrhage. J Neurol 255:347–352
Hanggi D, Steiger HJ (2008) Spontaneous intracerebral haemorrhage in adults: a literature overview. Acta Neurochir (Wien) 150:371–379, discussion 379
Kalita J, Misra UK, Vajpeyee A, Phadke RV, Handique A, Salwani V (2009) Brain herniations in patients with intracerebral hemorrhage. Acta Neurol Scand 119:254–260
Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, Khoury J (1996) The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27:1304–1305
Lim JK, Hwang HS, Cho BM, Lee HK, Ahn SK, Oh SM, Choi SK (2008) Multivariate analysis of risk factors of hematoma expansion in spontaneous intracerebral hemorrhage. Surg Neurol 69:40–45, discussion 45
Mayfrank L, Kissler J, Raoofi R, Delsing P, Weis J, Kuker W, Gilsbach JM (1997) Ventricular dilatation in experimental intraventricular hemorrhage in pigs. Characterization of cerebrospinal fluid dynamics and the effects of fibrinolytic treatment. Stroke 28:141–148
Moussouttas M, Malhotra R, Fernandez L, Maltenfort M, Holowecki M, Delgado J, Lawson N, Badjatia N (2010) Role of antiplatelet agents in hematoma expansion during the acute period of intracerebral hemorrhage. Neurocrit Care 12:24–29
Moussouttas M, Malhotra R, Fernandez L, Maltenfort M, Holowecki M, Delgado J, Lawson N, Badjatia N (2011) Impact of intraventricular hemorrhage upon intracerebral hematoma expansion. Neurocrit Care 14:50–54
Naidech AM, Jovanovic B, Liebling S, Garg RK, Bassin SL, Bendok BR, Bernstein RA, Alberts MJ, Batjer HH (2009) Reduced platelet activity is associated with early clot growth and worse 3-month outcome after intracerebral hemorrhage. Stroke 40:2398–2401
Phan TG, Koh M, Vierkant RA, Wijdicks EF (2000) Hydrocephalus is a determinant of early mortality in putaminal hemorrhage. Stroke 31:2157–2162
Rosand J, Eckman MH, Knudsen KA, Singer DE, Greenberg SM (2004) The effect of warfarin and intensity of anticoagulation on outcome of intracerebral hemorrhage. Arch Intern Med 164:880–884
Saloheimo P, Ahonen M, Juvela S, Pyhtinen J, Savolainen ER, Hillbom M (2006) Regular aspirin-use preceding the onset of primary intracerebral hemorrhage is an independent predictor for death. Stroke 37:129–133
Sansing LH, Messe SR, Cucchiara BL, Cohen SN, Lyden PD, Kasner SE (2009) Prior antiplatelet use does not affect hemorrhage growth or outcome after ICH. Neurology 72:1397–1402
Serebruany VL, Aradi D, Kim MH, Sibbing D (2013) Cangrelor infusion is associated with an increased risk for bleeding: Meta-analysis of randomized trials. Int J Cardiol 169:225–228
Silva Y, Leira R, Tejada J, Lainez JM, Castillo J, Davalos A (2005) Molecular signatures of vascular injury are associated with early growth of intracerebral hemorrhage. Stroke 36:86–91
Sinhal AR, Aylward PE (2013) New antiplatelet agents and the role of platelet function testing in acute coronary syndromes. Clin Ther 35:1064–1068
Sorimachi T, Fujii Y, Morita K, Tanaka R (2007) Predictors of hematoma enlargement in patients with intracerebral hemorrhage treated with rapid administration of antifibrinolytic agents and strict blood pressure control. J Neurosurg 106:250–254
Staykov D, Volbers B, Wagner I, Huttner HB, Doerfler A, Schwab S, Bardutzky J (2011) Prognostic significance of third ventricle blood volume in intracerebral haemorrhage with severe ventricular involvement. J Neurol Neurosurg Psychiatry 82:1260–1263
Stein M, Luecke M, Preuss M, Boeker DK, Joedicke A, Oertel MF (2010) Spontaneous intracerebral hemorrhage with ventricular extension and the grading of obstructive hydrocephalus: the prediction of outcome of a special life-threatening entity. Neurosurgery 67:1243–1251, discussion 1252
Steiner T, Diringer MN, Schneider D, Mayer SA, Begtrup K, Broderick J, Skolnick BE, Davis SM (2006) Dynamics of intraventricular hemorrhage in patients with spontaneous intracerebral hemorrhage: risk factors, clinical impact, and effect of hemostatic therapy with recombinant activated factor VII. Neurosurgery 59:767–773, discussion 773–764
Wada R, Aviv RI, Fox AJ, Sahlas DJ, Gladstone DJ, Tomlinson G, Symons SP (2007) CT angiography “spot sign” predicts hematoma expansion in acute intracerebral hemorrhage. Stroke 38:1257–1262
Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, Freij A, Thorsen M (2009) Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 361:1045–1057
Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM (2007) Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 357:2001–2015
Yildiz OK, Arsava EM, Akpinar E, Topcuoglu MA (2012) Previous antiplatelet use is associated with hematoma expansion in patients with spontaneous intracerebral hemorrhage. J Stroke Cerebrovasc Dis 21:760–766
Conflict of Interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yang, N., Kim, S.J. & Seo, E.K. Spontaneous intracerebral hemorrhage with antiplatelets/anticoagulants/none: a comparison analysis. Acta Neurochir 156, 1319–1325 (2014). https://doi.org/10.1007/s00701-014-2080-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-014-2080-2