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Sebök M, Hostettler IC, Keller E, Rautalin IM, Coert BA, Vandertop WP, Post R, Sardeha A, Tjerkstra MA, Regli L, Verbaan D, Germans MR. Prehemorrhage antiplatelet use in aneurysmal subarachnoid hemorrhage and impact on clinical outcome. Int J Stroke 2021; 17:545-552. [PMID: 34282988 PMCID: PMC9150139 DOI: 10.1177/17474930211035647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Literature is inconclusive regarding the association between antiplatelet agents use and outcome after aneurysmal subarachnoid hemorrhage. Aims To investigate the association between clinical outcome and prehemorrhage use in aneurysmal subarachnoid hemorrhage patients as well as the impact of thrombocyte transfusion on rebleed and clinical outcome. Methods Data were collected from prospective databases of two European tertiary reference centers for aneurysmal subarachnoid hemorrhage patients. Patients were divided into “antiplatelet-user” and “non-user” according to the use of acetylsalicylic acid prior to the hemorrhage. Primary outcome was poor clinical outcome at six months (Glasgow Outcome Scale score 1–3). Secondary outcomes were in-hospital mortality and impact of thrombocyte transfusion. Results Of the 1033 patients, 161 (15.6%) were antiplatelet users. The antiplatelet users were older with higher incidence of cardiovascular risk factors. Antiplatelet use was associated with poor outcome and in-hospital mortality. After correction for age, sex, World Federation of Neurosurgical Societies score, infarction and heart disorder, pre-hemorrhage acetylsalicylic acid use was only associated with poor clinical outcome at six months (adjusted OR 1.80, 95% CI 1.08–3.02). Thrombocyte transfusion was not associated with a reduction in rebleed or poor clinical outcome. Conclusion In this multicenter study, the prehemorrhage acetylsalicylic acid use in aneurysmal subarachnoid hemorrhage patients was independently associated with poor clinical outcome at six months. Thrombocyte transfusion was not associated with the rebleed rate or poor clinical outcome at six months.
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Affiliation(s)
- Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Isabel C Hostettler
- Stroke Research Centre, University College London, Institute of Neurology, London, UK.,Department of Neurosurgery, Klinikum rechts der Isar, Munich, Germany
| | - Emanuela Keller
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Neurosurgical Intensive Care Unit, Department of Neurosurgery and Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Ilari M Rautalin
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Bert A Coert
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - William P Vandertop
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - René Post
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ali Sardeha
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Maud A Tjerkstra
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Menno R Germans
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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