RT Journal Article
T1 Outcomes in Antiplatelet-Associated Intracerebral Hemorrhage in the TICH-2 Randomized Controlled Trial.
A1 Law, Zhe Kang
A1 Desborough, Michael
A1 Roberts, Ian
A1 Al-Shahi Salman, Rustam
A1 England, Timothy J
A1 Werring, David J
A1 Robinson, Thompson
A1 Krishnan, Kailash
A1 Dineen, Robert
A1 Laska, Ann Charlotte
A1 Peters, Nils
A1 Egea-Guerrero, Juan Jose
A1 Karlinski, Michal
A1 Christensen, Hanne
A1 Roffe, Christine
A1 Bereczki, Daniel
A1 Ozturk, Serefnur
A1 Thanabalan, Jegan
A1 Collins, Rónán
A1 Beridze, Maia
A1 Bath, Philip M
A1 Sprigg, Nikola
K1 antiplatelet
K1 cerebral hemorrhage
K1 hematoma expansion
K1 randomized controlled trial
K1 tranexamic acid
AB Background Antiplatelet therapy increases the risk of hematoma expansion in intracerebral hemorrhage (ICH) while the effect on functional outcome is uncertain. Methods and Results This is an exploratory analysis of the TICH-2 (Tranexamic Acid in Intracerebral Hemorrhage-2) double-blind, randomized, placebo-controlled trial, which studied the efficacy of tranexamic acid in patients with spontaneous ICH within 8 hours of onset. Multivariable logistic regression and ordinal regression were performed to explore the relationship between pre-ICH antiplatelet therapy, and 24-hour hematoma expansion and day 90 modified Rankin Scale score, as well as the effect of tranexamic acid. Of 2325 patients, 611 (26.3%) had pre-ICH antiplatelet therapy. They were older (mean age, 75.7 versus 66.5 years), more likely to have ischemic heart disease (25.4% versus 2.7%), ischemic stroke (36.2% versus 6.3%), intraventricular hemorrhage (40.2% versus 27.5%), and larger baseline hematoma volume (mean, 28.1 versus 22.6 mL) than the no-antiplatelet group. Pre-ICH antiplatelet therapy was associated with a significantly increased risk of hematoma expansion (adjusted odds ratio [OR], 1.28; 95% CI, 1.01-1.63), a shift toward unfavorable outcome in modified Rankin Scale (adjusted common OR, 1.58; 95% CI, 1.32-1.91) and a higher risk of death at day 90 (adjusted OR, 1.63; 95% CI, 1.25-2.11). Tranexamic acid reduced the risk of hematoma expansion in the overall patients with ICH (adjusted OR, 0.76; 95% CI, 0.62-0.93) and antiplatelet subgroup (adjusted OR, 0.61; 95% CI, 0.41-0.91) with no significant interaction between pre-ICH antiplatelet therapy and tranexamic acid (P interaction=0.248). Conclusions Antiplatelet therapy is independently associated with hematoma expansion and unfavorable functional outcome. Tranexamic acid reduced hematoma expansion regardless of prior antiplatelet therapy use. Registration URL: https://www.isrctn.com; Unique identifier: ISRCTN93732214.
YR 2021
FD 2021-02-15
LK http://hdl.handle.net/10668/17182
UL http://hdl.handle.net/10668/17182
LA en
DS RISalud
RD Apr 11, 2025