Emergency Reversal of Clopidogrel in the Setting of Spontaneous Intracerebral Hemorrhage

Objective To compare outcomes in the setting of spontaneous intracerebral hemorrhage (ICH) in patients taking aspirin (acetylsalicylic acid [ASA]) versus patients taking clopidogrel before hospitalization. Methods Patients admitted to the neurosurgical service with a spontaneous ICH while taking an antiplatelet agent were prospectively identified and retrospectively reviewed. Two groups of 28 consecutive patients taking ASA or clopidogrel on admission were ultimately evaluated. Results Patients in the clopidogrel group had a mean age of 72.6 years, and patients in the ASA group had a mean age of 65.8 years ( P = 0.04). Patients taking clopidogrel before hospitalization were significantly more likely than patients taking ASA to experience an increase in hematoma volume ( P = 0.05). Patients in the ASA group trended toward being discharged to home more frequently than other destinations ( P = 0.07). The in-hospital mortality rates in this series were 14.3% for the ASA group and 28.6% for the clopidogrel group. However, this association did not reach statistical significance ( P = 0.19). Conclusions In this study, patients taking clopidogrel showed more hematoma expansion, higher in-hospital mortality rates, and a decreased likelihood of a home discharge compared with patients taking ASA alone.