gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Pretreatment with antiplatelet agents and oral anticoagulants in intracerebral hemorrhage: A subgroup analysis

Meeting Abstract

  • M. Stein - Neurochirurgische Klinik, Universitätsklinikum Gießen und Marburg, Gießen
  • B. Misselwitz - Arbeitsgruppe Schlaganfall Hessen
  • J. Herrmann - Büro für Statistik, Justus-Liebig-Universität Gießen, Gießen
  • W. Scharbrodt - Neurochirurgische Klinik, Universitätsklinikum Gießen und Marburg, Gießen
  • M.F. Oertel - Neurochirurgische Klinik, Universitätsklinikum Gießen und Marburg, Gießen

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.05.01

DOI: 10.3205/11dgnc126, URN: urn:nbn:de:0183-11dgnc1266

Published: April 28, 2011

© 2011 Stein et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: In previous studies, pretreatment with oral anticoagulants was identified as a predictor of in-hospital mortality after intracerebral hemorrhage (ICH). The present study was conducted to observe the relation between pretreatment with oral anticoagulants and antiplatelet agents in different ICH subgroups.

Methods: The current analysis was based on a large, country-wide stroke registry in Germany. Between the year 2007 and 2009, all cases with the final diagnosis of intracerebral hemorrhage (ICD-10 I61) were selected. Only patients with deep hematomas (I61.0), lobar (I61.1), cerebellar (I61.3) and brainstem hemorrhage (I61.4) were included. All analyzed parameters including International Classification of Diseases (ICD), pre-hospital status (modified Rankin Scale, mRS), age and pretreatment with antiplatelet agents or oral anticoagulants were collected prospectively. Endpoints were in-hospital mortality rate and unfavorable outcome at hospital discharge (mRS > 2).

Results: A total of 2754 patients were included in our analysis. A pretreatment with antiplatelet agents was found in 28.2%. Oral anticoagulants were taken by 16.5% at the time of the hemorrhage. Hematomas were located deep in the cerebrum, in a lobe, in the cerebellum and in the brainstem in 46.9%, 20.2%, 22.4% and 10.5% of the cases, respectively. Overall in-hospital mortality was 19.5%. An unfavorable outcome at hospital discharge was recorded in 75.8%. A pretreatment with antiplatelet agents was found to be a predictor for in-hospital mortality for deep intracerebral hematomas (OR: 1.4; 95% CI: 1 - 1.9; P = 0.034). After adjustment for age and pre-hospital status, a pretreatment with antiplatelet agents was no longer an independent predictor (OR: 1.0; 95% CI: 0.7 - 1.4; P = 0.914). A therapy with oral anticoagulants was identified as independent predictor of in-hospital mortality for deep intracerebral hematomas (OR: 1.7; 95 % CI 1.2 - 2.4; P = 0.003). After adjustment for age and pre-hospital status, pretreatment with oral anticoagulants remains an independent predictor (OR: 1.6; 95% CI: 1.1 - 2.4; P = 0.015). No statistical significant association was seen between pretreatment with antiplatelet agents or oral anticoagulants for in-hospital mortality and outcome for lobar, cerebellar, and brainstem hematomas after adjustment for age and pre-hospital status.

Conclusions: Pretreatment with oral anticoagulants is an independent predictor of in-hospital mortality only for deep intracerebral hematomas.