Aspirin use or reduced platelet activity predicts craniotomy after intracerebral hemorrhage

Andrew M Naidech*, Neil F. Rosenberg, Richard A Bernstein, H. Hunt Batjer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Background Craniotomy is potentially life-saving in selected patients with intracerebral hemorrhage (ICH). Aside from specific scenarios (cerebellar hemorrhage with hydrocephalus, midline shift from an accessible lesion, etc.) the indications for surgical decompression are controversial. Based on the earlier work that aspirin and reduced platelet activity are associated with larger hemorrhage size and hemorrhage growth, we tested the hypothesis that aspirin or reduced platelet activity would be associated with increased odds of craniotomy, likely through hemorrhage growth. Methods We prospectively identified patients with spontaneous ICH and routinely measured platelet activity on admission. Patients were prospectively tracked, and outcomes were obtained with the modified Rankin Scale (mRS). Results There were 187 patients in the sample. Craniotomy (N = 32, 17%) was associated with a higher initial ICH volume (37.9 [20-63] vs. 12 [5-24] ml, P < 0.001) and location (P = 0.005). In multivariate logistic regression, after controlling for ICH volume and location, any known aspirin use (OR 3.4, 95% CI 1.1-10.4, P = 0.03), platelet activity ≤550 aspirin reaction units (OR 3.1, 95% CI 1.05-9.3, P = 0.04), or an elevated PFA-EPI closure time (OR 3.2, 95% CI 1.02-10.3, P = 0.04) were associated with increased odds of craniotomy. Craniotomy was not associated with mRS at 14 days, 28 days, or 3 months. Conclusions After correction for ICH volume and location, aspirin use or reduced platelet activity was associated with similar increased odds for craniotomy.

Original languageEnglish (US)
Pages (from-to)442-446
Number of pages5
JournalNeurocritical Care
Volume15
Issue number3
DOIs
StatePublished - Dec 1 2011

Keywords

  • Aspirin
  • Craniotomy
  • Intracerebral hemorrhage
  • Outcomes
  • Platelets

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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