Is Antiplatelet Therapy for the Prevention of Ischemic Stroke Associated with the Prognosis of Intracerebral Hemorrhage?

To examine whether antiplatelet therapy contributes to the unfavorable prognosis of intracerebral hemorrhage, we enrolled 253 consecutive patients (120 men and 133 women; 72.9±11.7 years) hospitalized in our institution within 24 hrs after onset of intracerebral hemorrhage. The location and size of intracerebral hemorrhage were determined from computed tomography (CT). Hematoma enlargement was identified on the basis of a second computed tomography scan performed on the day after admission. An unfavorable prognosis was defined as an outcome of worsening or death using the modified Rankin Scale (mRS). Locations of intracerebral hemorrhage (ICH) determined from CT were the thalamus in 92 patients (36.3%), putamen in 79 (31.2%), subcortex in 35 (13.8%), cerebellum in 20 (7.9%), brainstem in 18 (7.1%), and caudate nucleus in 9 (3.5%). Sizes of ICH were small and moderate in 153 patients (60%) and large in 100 (40%). Seventeen patients (6.7%) received antiplatelet therapy for stroke prevention. Hematoma enlargement was identified in 39 patients (15.4%). Overall outcomes at the time of discharge were unfavorable (modified Rankin Scale score 5-6) in 64 patients (25.2%) and favorable mRS score (0-1∼4) in 189 (74.8%). Univariate analysis demonstrated that age ≥75 years (odds ratio: 2.78; 95%CI: 1.54-5.04) and presence of a large hematoma (odds ratio: 19.28; 95%CI: 8.84-42.1) were significantly related to the unfavorable prognosis. Using multiple logistic regression analysis after adjustments for age and sex, the presence of a large hematoma was still judged unfavorable; however, antiplatelet therapy was not related to unfavorable prognosis. Antiplatelet therapy may be unrelated to the unfavorable prognosis of ICH.