TY - JOUR
T1 - Medication History versus Point-of-Care Platelet Activity Testing in Patients with Intracerebral Hemorrhage
AU - Maas, Matthew B.
AU - Naidech, Andrew M.
AU - Kim, Minjee
AU - Batra, Ayush
AU - Manno, Edward M.
AU - Sorond, Farzaneh A.
AU - Prabhakaran, Shyam
AU - Liotta, Eric M.
N1 - Funding Information:
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.
Publisher Copyright:
© 2018 National Stroke Association
PY - 2018/5
Y1 - 2018/5
N2 - 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.
AB - 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.
KW - Intracerebral hemorrhage
KW - antiplatelet
KW - hemorrhagic stroke
KW - hemostasis
KW - intracranial hemorrhage
KW - platelet dysfunction
UR - http://www.scopus.com/inward/record.url?scp=85039953925&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85039953925&partnerID=8YFLogxK
U2 - 10.1016/j.jstrokecerebrovasdis.2017.11.033
DO - 10.1016/j.jstrokecerebrovasdis.2017.11.033
M3 - Article
C2 - 29310956
AN - SCOPUS:85039953925
SN - 1052-3057
VL - 27
SP - 1167
EP - 1173
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 5
ER -