Abstract
Objective: We evaluated whether reduced platelet activity detected by point-of-care (POC) testing is a better predictor of hematoma expansion and poor functional outcomes in patients with intracerebral hemorrhage (ICH) than a history of antiplatelet medication exposure. Methods: Patients presenting with spontaneous ICH were enrolled in a prospective observational cohort study that collected demographic, clinical, laboratory, and radiographic data. We measured platelet activity using the PFA-100 (Siemens AG, Germany) and VerifyNow-ASA (Accumetrics, CA) systems on admission. We performed univariate and adjusted multivariate analyses to assess the strength of association between those measures and (1) hematoma growth at 24 hours and (2) functional outcomes measured by the modified Rankin Scale (mRS) at 3 months. Results: We identified 278 patients for analysis (mean age 65 ± 15, median ICH score 1 [interquartile range 0-2]), among whom 164 underwent initial neuroimaging within 6 hours of symptom onset. Univariate association with hematoma growth was stronger for antiplatelet medication history than POC measures, which was confirmed in multivariable models (β 3.64 [95% confidence interval [CI] 1.02-6.26], P =.007), with a larger effect size measured in the under 6-hour subgroup (β 7.20 [95% CI 3.35-11.1], P <.001). Moreover, antiplatelet medication history, but not POC measures of platelet activity, was independently associated with poor outcome at 3 months (mRS 4-6) in the under 6-hour subgroup (adjusted OR 3.6 [95% CI 1.2-11], P =.023). Conclusion: A history of antiplatelet medication use better identifies patients at risk for hematoma growth and poor functional outcomes than POC measures of platelet activity after spontaneous ICH.
Original language | English (US) |
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Pages (from-to) | 1167-1173 |
Number of pages | 7 |
Journal | Journal of Stroke and Cerebrovascular Diseases |
Volume | 27 |
Issue number | 5 |
DOIs | |
State | Published - May 2018 |
Funding
Grant support: Dr. Maas receives support from National Institutes of Health grants K23NS092975 and L30NS080176. Dr. Naidech receives support from Agency for Healthcare Research and Quality grant K18HS023437. Dr. Liotta receives support from National Center for Advancing Translational Sciences grant KL2TR001424 and National Institutes of Health grant L30NS098427. Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences grant UL1TR000150. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Agency for Healthcare Research and Quality.
Keywords
- Intracerebral hemorrhage
- antiplatelet
- hemorrhagic stroke
- hemostasis
- intracranial hemorrhage
- platelet dysfunction
ASJC Scopus subject areas
- Surgery
- Rehabilitation
- Clinical Neurology
- Cardiology and Cardiovascular Medicine