Pretreatment with antiplatelet agents is not independently associated with unfavorable outcome in intracerebral hemorrhage
Pretreatment with antiplatelet agents is not independently associated with unfavorable outcome in intracerebral hemorrhage
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DOI：
10.1161/01.str.0000231842.32153.74
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发表时间：
2006-08-01
期刊：
影响因子：
8.3
通讯作者：
Neumann-Haefelin, Tobias
中科院分区：
文献类型：
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作者：
Foerch, Christian;Sitzer, Matthias;Neumann-Haefelin, Tobias
背景与目的：本研究探讨了既往抗血小板治疗对脑出血（ICH）患者死亡率和功能结局的影响。方法：我们的分析基于德国全国范围内的大型卒中登记。前瞻性记录与本分析相关的所有参数，包括年龄、院前状态（根据修改的Rankin量表，mRS）、基于疾病的国际分类诊断、抗血小板药物或口服抗凝剂的预处理。主要结局指标为住院死亡率和出院时功能状态（mRS）。结果：在2年的时间里，记录了1691例脑出血患者（ICD-10: 161），其中48%为女性，平均年龄72.12岁。在症状出现时，26%的患者服用抗血小板药物，12%的患者服用口服抗凝血药。通过单因素logistic回归，发现抗血小板药物或抗凝血药物预处理是院内死亡率的重要预测因子（优势比[or]， 1.42； P=0.008; or, 1.53; P < 0.001）和不良功能结局（定义为mRS bbb2或死亡；or, 1.33， P=0.039; or, 1.51, P < 0.001）。然而，在调整年龄和院前状态后，抗血小板预处理不再是院内死亡（OR, 1.12； P=0.490）或不良功能结局（OR, 0.97； P=0.830）的独立危险因素，而口服抗凝剂预处理的影响仍然显著（OR, 1.45; P < 0.001； OR, 1.42； P=0.009）。结论：与口服抗凝药物相比，抗血小板药物预处理不是脑出血患者死亡和不良结局的独立危险因素。
Background and Purpose-This study investigated the effect of preexisting antiplatelet therapy on mortality and functional outcome in patients with intracerebral hemorrhage (ICH).Methods-Our analysis was based on a large, country-wide stroke registry in Germany. All parameters relevant to this analysis, including age, prehospital status (according to the modified Rankin Scale, mRS), International Classification of Diseases-based diagnosis, and pretreatment with antiplatelet agents or oral anticoagulants, were recorded prospectively. Main outcome measures were in-hospital mortality rate and functional status at hospital discharge (mRS).Results-Over a 2-year period, 1691 patients with ICH (ICD-10: 161) were documented (48% female; mean age, 72 12 years). At symptom onset, 26% were taking antiplatelet agents, and 12% were taking oral anticoagulants. By univariate logistic regression, pretreatment with antiplatelet drugs or anticoagulants was found to be a significant predictor of in-hospital mortality (odds ratio [OR], 1.42; P=0.008; OR, 1.53; P < 0.001) and of an unfavorable functional outcome (defined as mRS > 2 or death; OR, 1.33, P=0.039; OR, 1.51; P < 0.001). However, after adjustment for age and prehospital status, antiplatelet pretreatment was no longer an independent risk factor of in-hospital death (OR, 1.12; P=0.490) or unfavorable functional outcome (OR, 0.97; P=0.830), whereas the influence of pretreatment with oral anticoagulants remained significant (OR, 1.45; P < 0.001; OR, 1.42; P=0.009).Conclusions-In contrast to oral anticoagulants, pretreatment with antiplatelet agents is not an independent risk factor of mortality and unfavorable outcome in patients with ICH.