| Objective: To analysis the clinical and radiological characteristics of oral antithrombotic-associated intracerebral hemorrhage(ICH),and evaluate whether the effect of antithrombotic medications on the risk of ICH varies according to the hemorrhage location.Methods: A total of 2455 consecutive ICH patients were retrospectively enrolled from the First Affiliated Hospital of Soochow University,from May 01,2012 to May 31,2017.After excluding those patients who did not meet the inclusion criteria,a total 627 patients made up our study population and clinical and radiographic data of these patients were collected.All patients were divided into 3 groups: oral antiplatelet agent-related ICH,oral anticoagulant-related ICH and control group(without using any drugs that influence ICH volumes).According to the hemorrhage location,they were also divided into lobar(frontal,temporal,parietal,occipital and cerebellum)ICH(when the origin of the hemorrhage appeared to be in thecerebral cortex to the subcortical white matter)and deep ICH(when originating from the basal ganglia,thalamus or brain stem).By using a multiple linear regression model to analyze the effect of oral antithrombotic drugs on the amount of cerebral hemorrhage.A multivariate logistic regression model was used to analyze the risk factors for ICH and the relationship between oral antithrombotic drugs and the location of cerebral hemorrhage.Results: Among 627 ICH patients,118(18.8%)patients received antithrombotic drugs before admission,with aspirin 60 cases(50.8%),clopidogrel 6 cases(5.1%),aspirin and clopidogrel 14 cases(11.9%),and warfarin 38 cases(32.2%).Compared with patientswho didn’t take antithrombotic drugs,oral antiplatelet agent-related ICH patients was older,the incidence of diabetes was higher and the incidence of hyperlipidemia was lower.The history of ischemic stroke,atrial fibrillation,ischemia heart disease and peripheral vascular diseases are commonwith the oral antiplatelet agent-related ICH patients.Most of patients were given antihypertensive drugs,hypoglycemic agents and statins before admission.And they had lower GCS score at admission and higher in-hospital mortality.There were no differences in sexes,smoking,drinking and the history of hemorrhagic stroke before admission.Compared with patientswho didn’t take antithrombotic drugs,the oral anticoagulant-related ICH patients had no significant difference in gender,age and GCS score at admission.But the incidence of hyperlipidemia was lower,most of patients had ischemic stroke,atrial fibrillation and taking statins.There was a significant difference in the in-hospital mortality between the two groups.Patients taking warfarin had larger ICH volumes and higher mortality.Compared with ICH patients who didn’t take antithrombotic drug,there was a lager hemorrhage volumes in patients with oral antithrombotic drug(P <0.001).In the lobar ICH,the use of oral antiplatelet agents and oral anticoagulants both influence the ICH volume(44.65 ml vs 26.43 ml,P =0.001 and 45.40 ml vs 26.43 ml,P =0.024).Whereas in deep ICH,oral anticoagulants had a greater impact on ICH volume(50.93 ml vs 24.88 ml,P<0.001).Oral antiplatelet agents use did not influence the volume(31.50 ml vs 24.88 ml,P =0.092).After excluding the subgroup of cerebellar hemorrhage patients,the data were reanalyzed and we found that oral antiplatelet agents still influence hemorrhage volume in the lobar ICH(58.31 ml vs 35.92 ml,P =0.002).While the impact of oral anticoagulants on ICH volume didn’t have statistically significant(45.40 ml vs 35.92 ml,P =0.171).In the lobar ICH,the international normalized ratio(INR)value was not related to ICH volume(P for trend =0.395).But in deep ICH,the hemorrhage volume increased with the increasing value of INR and the increasing trend have statistically significant(P for trend =0.002).Oral antiplatelet agents(OR =2.34,95%CI 1.408-3.896,P =0.001)and age increasing(OR =1.03,95%CI 1.013-1.042,P <0.001)made ICHprone to lobar location.While the use of oral anticoagulants had no significant effect on the location of ICH(OR =0.80,95%CI 0.370-1.746,P =0.581)and patients with high blood pressure were more likely to develop deep ICH(OR =0.34,95%CI 0.199-0.584,P <0.001).But diabetes,smoking,alcohol consumption or hyperlipidemia didn’t independentlyinfluencethe ICHlocationin oral antithrombotic-related ICH patients(P >0.05).Conclusion: ICHin patients taking oral antiplatelet agents predispose to lobar location.In lobar ICH,antiplatelet agents will increase ICH volumes,and anticoagulants without this effect.However,oral anticoagulants have not significantinfluenceon the location of ICH.But in deep ICH,patients taking anticoagulants have lager ICH volumes,and those taking antiplatelet agents increase ICH volumes have no statistical difference.Therefore,oral antithrombotic drugs should not be considered as a single cause of ICH,but should also consider potential vascular lesions. |
