gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Pretreatment with antiplatelet agents is associated with increased in-hospital mortality after hematoma evacuation of supratentorial intracerebral hematomas

Meeting Abstract

  • Marco Stein - Department of Neurosurgery, University Clinics of Giessen and Marburg GmbH, Campus Giessen, Germany
  • Björn Misselwitz - Institute of Quality Assurance Hesse, Eschborn, Germany
  • Gerhard F. Hamann - Neurological Clinic, Dr. Horst Schmidt Clinic, Wiesbaden, Germany
  • Marcus Reinges - Department of Neurosurgery, University Clinics of Giessen and Marburg GmbH, Campus Giessen, Germany
  • Eberhard Uhl - Department of Neurosurgery, University Clinics of Giessen and Marburg GmbH, Campus Giessen, Germany

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMI.14.07

doi: 10.3205/13dgnc401, urn:nbn:de:0183-13dgnc4018

Published: May 21, 2013

© 2013 Stein et al.
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Outline

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Objective: The role of antiplatelet agents and oral anticoagulants in terms of in-hospital mortality after spontaneous intracerebral hemorrhage (ICH) is still controversial. This study was performed to evaluate the role of pretreatment with antiplatelet agents and oral anticoagulants on in-hospital mortality after hematoma evacuation and after conservative treatment of spontaneous supratentorial ICH.

Method: The analysis is based on a prospective stroke registry in the state of Hesse, Germany. Patients' data with the diagnosis of supratentorial ICH from January 2007 to December 2010 were reviewed. Only patients with the diagnosis of supratentorial ICH were included (ICD-10: I61.0, ICD-10: I61.1, ICD-10: I61.2). Logistic regression analysis was adjusted for age, pre-hospital status, initial Glasgow Coma Score, and the presence of intraventricular hemorrhage.

Results: In 3230 patients with spontaneous supratentorial ICH a pretreatment with oral anticoagulants, antiplatelet agents or both was documented in 16.7%, 28.4% and 1.5%, respectively. Antiplatelet pretreatment had no effect on in-hospital mortality in the overall analysis (OR: 1.1; CI: 0.83–1.32; P=0.676). However, in a subgroup analysis patients with antiplatelet pretreatment had a significant higher risk to die in the hospital after hematoma evacuation (OR: 8.7; 95% CI: 1.94–11.70; P=0.001) compared to patients with conservative treatment (OR: 0.9; 95% CI: 0.74–1.20; P=0.615). Pretreatment with oral anticoagulants is associated with higher in-hospital mortality in the overall analysis (OP: 1.4; 95% CI: 1.05–1.77; P=0.022) and in conservative treated patients (OR: 1.4; 95% CI: 1.08–1.89; P=0.013), but not in operative treated patients (OR: 1.4; 95% CI: 0.49–3.82; P=0.543).

Conclusions: Pretreatment with antiplatelet agents is not associated with increased in-hospital mortality in all ICH patients. After hematoma evacuation of supratentorial ICH in patients on antiplatelet treatment, a significant higher rate of in-hospital mortality was observed.