PMID- 28148636
OWN - NLM
STAT- MEDLINE
DCOM- 20170519
LR  - 20170519
IS  - 1526-632X (Electronic)
IS  - 0028-3878 (Linking)
VI  - 88
IP  - 9
DP  - 2017 Feb 28
TI  - Antithrombotic pretreatment increases very-early mortality in primary 
      intracerebral hemorrhage.
PG  - 885-891
LID - 10.1212/WNL.0000000000003659 [doi]
AB  - OBJECTIVE: To analyze the effect of previous antiplatelet (AP) and vitamin K 
      antagonist (VKA) treatments on outcome in patients with primary intracerebral 
      hemorrhage (ICH). METHODS: In this prospective observational study, we analyzed 
      529 patients according to antithrombotic pretreatment: none, AP, or VKA. 
      Very-early (24-hour) death, 3-month mortality, and functional independence were 
      analyzed. RESULTS: Of 236 (44.6%) pretreated patients, 147 (27.8%) patients were 
      taking AP and 89 (16.8%) VKA. Very-early death was observed in 13.4% and was 
      increased in pretreated patients: 19.0% for AP and 27.0% for VKA treatment, 
      compared to 6.5% in non-pretreated patients, p < 0.0001. Three-month mortality 
      was 40.8% overall (49.7% for AP pretreated, 58.4% for VKA pretreated, and 31.1% 
      for non-pretreated patients, p < 0.0001). The adjusted odds of very-early and 
      3-month mortality were 2.55 (p = 0.004) and 1.56 (p = 0.046) for AP-pretreated 
      patients and 4.24 (p < 0.0001) and 2.34 (p = 0.01) for VKA-pretreated patients, 
      respectively, compared with non-pretreated patients. The effect of antithrombotic 
      pretreatment on mortality from 24 hours to 3 months was nonsignificant. At 
      3-month follow-up, 28.5% of patients remained functionally independent: 22.4% of 
      AP-pretreated, 15.7% of VKA-pretreated, and 35.5% of non-pretreated patients (p < 
      0.0001). CONCLUSIONS: A high percentage of patients with ICH preventively treated 
      with VKA or AP died during the first 24 hours after admission. Both treatments 
      were predictors of very-early mortality. The final effect of antithrombotics on 
      3-month mortality remains significant through its strong effect on very-early 
      mortality. Safety concerns about starting chronic antithrombotic treatment should 
      be considered not only when VKA treatment is planned but also for AP treatment.
CI  - (c) 2017 American Academy of Neurology.
FAU - Roquer, Jaume
AU  - Roquer J
AD  - From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., 
      C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., 
      A.R.C., J.J.C.), Universitat Autonoma de Barcelona; and DCEXS (E.C.G.), 
      Universitat Pompeu Fabra, Barcelona, Spain. jroquer@hospitaldelmar.cat.
FAU - Vivanco Hidalgo, Rosa Maria
AU  - Vivanco Hidalgo RM
AD  - From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., 
      C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., 
      A.R.C., J.J.C.), Universitat Autonoma de Barcelona; and DCEXS (E.C.G.), 
      Universitat Pompeu Fabra, Barcelona, Spain.
FAU - Ois, Angel
AU  - Ois A
AD  - From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., 
      C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., 
      A.R.C., J.J.C.), Universitat Autonoma de Barcelona; and DCEXS (E.C.G.), 
      Universitat Pompeu Fabra, Barcelona, Spain.
FAU - Rodriguez Campello, Ana
AU  - Rodriguez Campello A
AD  - From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., 
      C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., 
      A.R.C., J.J.C.), Universitat Autonoma de Barcelona; and DCEXS (E.C.G.), 
      Universitat Pompeu Fabra, Barcelona, Spain.
FAU - Cuadrado Godia, Elisa
AU  - Cuadrado Godia E
AD  - From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., 
      C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., 
      A.R.C., J.J.C.), Universitat Autonoma de Barcelona; and DCEXS (E.C.G.), 
      Universitat Pompeu Fabra, Barcelona, Spain.
FAU - Giralt Steinhauer, Eva
AU  - Giralt Steinhauer E
AD  - From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., 
      C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., 
      A.R.C., J.J.C.), Universitat Autonoma de Barcelona; and DCEXS (E.C.G.), 
      Universitat Pompeu Fabra, Barcelona, Spain.
FAU - Gomez Gonzalez, Alejandra
AU  - Gomez Gonzalez A
AD  - From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., 
      C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., 
      A.R.C., J.J.C.), Universitat Autonoma de Barcelona; and DCEXS (E.C.G.), 
      Universitat Pompeu Fabra, Barcelona, Spain.
FAU - Soriano-Tarraga, Carolina
AU  - Soriano-Tarraga C
AD  - From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., 
      C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., 
      A.R.C., J.J.C.), Universitat Autonoma de Barcelona; and DCEXS (E.C.G.), 
      Universitat Pompeu Fabra, Barcelona, Spain.
FAU - Jimenez Conde, Jordi
AU  - Jimenez Conde J
AD  - From Servei de Neurologia (J.R., R.M.V.H., A.O., A.R.C., E.C.G., E.G.S., A.G.G., 
      C.S.-T., J.J.C.), IMIM-Hospital del Mar; Departament de Medicina (J.R., A.O., 
      A.R.C., J.J.C.), Universitat Autonoma de Barcelona; and DCEXS (E.C.G.), 
      Universitat Pompeu Fabra, Barcelona, Spain.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20170201
PL  - United States
TA  - Neurology
JT  - Neurology
JID - 0401060
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 12001-79-5 (Vitamin K)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Cerebral Hemorrhage/*drug therapy/*mortality
MH  - Female
MH  - Fibrinolytic Agents/*adverse effects/therapeutic use
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/*adverse effects/therapeutic use
MH  - Prospective Studies
MH  - Regression Analysis
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Survival Analysis
MH  - Time Factors
MH  - Vitamin K/*agonists
EDAT- 2017/02/06 06:00
MHDA- 2017/05/20 06:00
CRDT- 2017/02/03 06:00
PHST- 2016/07/08 00:00 [received]
PHST- 2016/10/06 00:00 [accepted]
PHST- 2017/02/06 06:00 [pubmed]
PHST- 2017/05/20 06:00 [medline]
PHST- 2017/02/03 06:00 [entrez]
AID - WNL.0000000000003659 [pii]
AID - 10.1212/WNL.0000000000003659 [doi]
PST - ppublish
SO  - Neurology. 2017 Feb 28;88(9):885-891. doi: 10.1212/WNL.0000000000003659. Epub 
      2017 Feb 1.