Prior Oral Antithrombotic Therapy is Associated with Early Death in Patients with Supratentorial Intracerebral Hemorrhage

Background And Purpose: Although oral antithrombotic therapy (OAT) is a risk factor of intracerebral hemorrhage (ICH), the clinical course of supratentorial ICH with prior OAT is unclear. We therefore assessed the characteristics of supratentorial ICH with OAT to determine whether OAT is independently associated with early death in supratentorial ICH.

Method: We retrospectively enrolled consecutive patients with supratentorial ICH admitted to the Stroke Center of Kawasaki Medical School Hospital within 24 hours of onset, from April 2004 to March 2009. The group with OAT therapy (OA group) was compared with the group without (non-OA group).

Results: A total of 389 patients with supratentorial ICH (median age 68 years, 61% males) were enrolled in the present study. OAT was used in 24% of patients. The OA group was older than the non-OA group (median 74 vs. 66 years, p<0.001). In the OA group, Glasgow Coma Scale was less (10 vs. 13, p<0.001), and hematomas were larger (22 mL vs. 14 mL, p<0.001). Early death was more frequently observed in the OA group than in the non-OA group (28% vs. 8.1%, p<0.001). Unadjusted HR of OAT for death within 14 days was 3.62 (95% CI: 2.06-6.33, p<0.001), the age- and sex-adjusted HR was 3.84 (95% CI: 2.12-6.96, p<0.001), and HR adjusted for age, sex, GCS, and hematoma volume was 2.01 (95% CI: 1.11-3.65, p=0.022). HR adjusted for age, sex, GCS, and hematoma volume at day 1 was 2.63 (p=0.34), day 3: 2.35 (p=0.03), day 7: 2.01 (p=0.04), and day 14: 1.90 (p=0.04).

Conclusion: The OA group patients were older, their GCS was lower, they had larger hematoma volume, and more frequent occurrence of early death. Prior oral antithrombotic therapy is associated with early death in patients with supratentorial ICH.