TY - JOUR
T1 - Prior antiplatelet therapy and haematoma expansion after primary intracerebral haemorrhage
T2 - An individual patient-level analysis of CLEAR III, MISTIE III and VISTA-ICH
AU - Murthy, Santosh
AU - Roh, David J.
AU - Chatterjee, Abhinaba
AU - McBee, Nichol
AU - Parikh, Neal S.
AU - Merkler, Alexander E.
AU - Navi, Babak B.
AU - Falcone, Guido J.
AU - Sheth, Kevin N.
AU - Awad, Issam
AU - Hanley, Daniel
AU - Kamel, Hooman
AU - Ziai, Wendy C.
N1 - Funding Information:
Funding The study was funded by the National Institutes of Health grants (K23NS105948) to SBM, and (U01-NS08082 and U01-NS080824) to DH and WCZ.
Funding Information:
Competing interests BBN is supported by the NIH (K23NS091395) and the
Funding Information:
Florence Gould Endowment for Discovery in Stroke, serves as a member of the data and safety monitoring board for the PCORI-funded TRAVERSE trial and has received personal fees for medicolegal consulting on stroke. AEM is supported by AHA grant 18CDA34110419 and the Leon Levy Foundation. He has received personal fees for medicolegal consulting on stroke. GJF is supported by the NIH (K76AG059992, R03NS112859), the American Heart Association (18IDDG34280056) and the Yale Pepper Scholar Award (P30AG021342). KNS is supported by the NIH (U24NS107215, U24NS107136, RO1NR018335, and U01NS106513), Novartis, and Bard, and reports grants from Hyperfine, Biogen, and Astrocyte unrelated to this work. DH is supported by the NIH (U01NS080824 and U24TR001609), and reports personal fees from Op2Lysis, personal fees from BrainScope and Neurotrope, and non-financial support from Genentech outside the submitted work. HK is supported by the NIH (U01NS095869 and R01NS097443) and the Michael Goldberg Research Fund; serves as the co-PI for the NIH-funded ARCADIA trial which receives in-kind study drug from the BMS-Pfizer Alliance and in-kind study assays from Roche Diagnostics; serves as a steering committee member of Medtronic’s Stroke AF trial (uncompensated); serves on an endpoint adjudication committee for a trial of empagliflozin for Boehringer-Ingelheim; and has served on an advisory board for Roivant Sciences related to Factor XI inhibition. WCZ receives consulting fees from C.R. Bard, Inc. outside of the area of work commented on here. All remaining authors declare no competing interests.
Publisher Copyright:
© Author(s) (or their employer(s)) 2021.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/4/1
Y1 - 2021/4/1
N2 - Objective To evaluate the relationship between prior antiplatelet therapy (APT) and outcomes after primary intracerebral haemorrhage (ICH), and assess if it varies by haematoma location. Methods We pooled individual patient data from the Virtual International Stroke Trials Archive-ICH trials dataset, Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage III trial and the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation Phase III trial. The exposure was APT preceding ICH diagnosis. The primary outcome was haematoma expansion at 72 hours. Secondary outcomes were admission haematoma volume, all-cause mortality, death or major disability (modified Rankin Scale (mRS) score ≥4) and shift in mRS distribution. Mixed-effects models were used to assess the relationship between APT and outcomes. Secondary analyses were stratified by ICH location and study cohort. Results Among 1420 patients with ICH, there were 782 (55.1%) lobar and 596 (42.0%) deep haemorrhages. APT was reported in 284 (20.0%) patients. In adjusted regression models, prior APT was not associated with haematoma expansion (OR, 0.97; 95% CI 0.60 to 1.57), major disability or death (OR, 1.05; 95% CI 0.61 to 1.63), all-cause mortality (OR, 0.89; 95% CI 0.47 to 1.85), admission haematoma volume (beta, -0.17; SE, 0.09; p=0.07) and shift in mRS (p=0.43). In secondary analyses, APT was associated with admission haematoma volume in lobar ICH (beta, 0.25; SE, 0.12; p=0.03), but there was no relationship with other ICH outcomes when stratified by haematoma location or study cohort. Conclusions In a large heterogeneous cohort of patients with ICH, prior APT was not associated with haematoma expansion or functional outcomes after ICH, regardless of haematoma location. APT was associated with admission haematoma volumes in lobar ICH.
AB - Objective To evaluate the relationship between prior antiplatelet therapy (APT) and outcomes after primary intracerebral haemorrhage (ICH), and assess if it varies by haematoma location. Methods We pooled individual patient data from the Virtual International Stroke Trials Archive-ICH trials dataset, Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage III trial and the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation Phase III trial. The exposure was APT preceding ICH diagnosis. The primary outcome was haematoma expansion at 72 hours. Secondary outcomes were admission haematoma volume, all-cause mortality, death or major disability (modified Rankin Scale (mRS) score ≥4) and shift in mRS distribution. Mixed-effects models were used to assess the relationship between APT and outcomes. Secondary analyses were stratified by ICH location and study cohort. Results Among 1420 patients with ICH, there were 782 (55.1%) lobar and 596 (42.0%) deep haemorrhages. APT was reported in 284 (20.0%) patients. In adjusted regression models, prior APT was not associated with haematoma expansion (OR, 0.97; 95% CI 0.60 to 1.57), major disability or death (OR, 1.05; 95% CI 0.61 to 1.63), all-cause mortality (OR, 0.89; 95% CI 0.47 to 1.85), admission haematoma volume (beta, -0.17; SE, 0.09; p=0.07) and shift in mRS (p=0.43). In secondary analyses, APT was associated with admission haematoma volume in lobar ICH (beta, 0.25; SE, 0.12; p=0.03), but there was no relationship with other ICH outcomes when stratified by haematoma location or study cohort. Conclusions In a large heterogeneous cohort of patients with ICH, prior APT was not associated with haematoma expansion or functional outcomes after ICH, regardless of haematoma location. APT was associated with admission haematoma volumes in lobar ICH.
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U2 - 10.1136/jnnp-2020-323458
DO - 10.1136/jnnp-2020-323458
M3 - Article
C2 - 33106367
AN - SCOPUS:85094865544
VL - 92
SP - 364
EP - 369
JO - Journal of Neurology, Neurosurgery and Psychiatry
JF - Journal of Neurology, Neurosurgery and Psychiatry
SN - 0022-3050
IS - 4
ER -