Abstract WMP102: Antiplatelet Therapy in Intracerebral Hemorrhage

Introduction: This study determined the influence of concomitant antiplatelet therapy (APT) on hematoma characteristics and outcome in primary spontaneous intracerebral hemorrhage (non-OAC-ICH), vitamin K antagonist (VKA-) and non-vitamin K antagonist oral anticoagulant (NOAC-) associated ICH. Methods: Data of retrospective cohort studies and a prospective single-center study were pooled. Functional outcome, mortality and radiological characteristics were defined as primary and secondary outcomes. Propensity-score(PS)-matching and logistic regression analyses were performed to determine the association between single or dual antiplatelet therapy and hematoma volume. Results: A total of 3,580 ICH patients were screened, of whom 3,545 with information on antiplatelet therapy were analyzed. 346(32.4%) patients in non-OAC-ICH, 260(11.4%) in VKA-ICH and 30(16.0%) in NOAC-ICH were on APT and these patients had more severe comorbidities. After PS matching VKA-ICH patients on APT presented with less favorable functional outcome (mRS=0-3: APT:48/202[23.8%] vs no-APT:187/587[31.9%]; p=0.030) and higher mortality (APT:103/202[51.0%] vs no-APT:237/587[40.4%]; p=0.009), while no significant differences were present in non-OAC-ICH and NOAC-ICH. In VKA-ICH hematoma volume was significantly larger in patients with APT (21.9[7.4-61.4]ml vs 15.7[5.7-44.5]ml; p=0.005). Multivariable regression analysis revealed an association of APT and larger ICH volumes (OR: 1.80[1.20-2.70]; p=0.005), which was more pronounced in dual APT and supratherapeutically anticoagulated patients. Conclusions: APT does not affect ICH characteristics and outcome in non-OAC-ICH patients, however is associated with larger ICH volume and worse functional outcome in VKA-ICH, presumably by additive anti-hemostatic effects. Combination of anticoagulation and antiplatelet therapy should therefore be diligently evaluated and restricted to the shortest possible time frame.