Outcomes in Antiplatelet‐Associated Intracerebral Hemorrhage in the TICH‐2 Randomized Controlled Trial

Law, Zhe Kang; Desborough, Michael; Roberts, Ian; Al?Shahi Salman, Rustam; England, Timothy J.; Werring, David J.; Robinson, Thompson; Krishnan, Kailash; Dineen, Robert; Laska, Ann Charlotte; Peters, Nils; Egea?Guerrero, Juan Jose; Karlinski, Michal; Christensen, Hanne; Roffe, Christine; Bereczki, Daniel; Ozturk, Serefnur; Thanabalan, Jegan; Collins, R�n�n; Beridze, Maia; Bath, Philip M.; Sprigg, Nikola

Abstract

Background
Antiplatelet therapy increases the risk of hematoma expansion in intracerebral hemorrhage (ICH) while the effect on functional outcome is uncertain.

Methods and Results
This is an exploratory analysis of the TICH‐2 (Tranexamic Acid in Intracerebral Hemorrhage‐2) double‐blind, randomized, placebo‐controlled trial, which studied the efficacy of tranexamic acid in patients with spontaneous ICH within 8 hours of onset. Multivariable logistic regression and ordinal regression were performed to explore the relationship between pre‐ICH antiplatelet therapy, and 24‐hour hematoma expansion and day 90 modified Rankin Scale score, as well as the effect of tranexamic acid. Of 2325 patients, 611 (26.3%) had pre‐ICH antiplatelet therapy. They were older (mean age, 75.7 versus 66.5 years), more likely to have ischemic heart disease (25.4% versus 2.7%), ischemic stroke (36.2% versus 6.3%), intraventricular hemorrhage (40.2% versus 27.5%), and larger baseline hematoma volume (mean, 28.1 versus 22.6 mL) than the no‐antiplatelet group. Pre‐ICH antiplatelet therapy was associated with a significantly increased risk of hematoma expansion (adjusted odds ratio [OR], 1.28; 95% CI, 1.01–1.63), a shift toward unfavorable outcome in modified Rankin Scale (adjusted common OR, 1.58; 95% CI, 1.32–1.91) and a higher risk of death at day 90 (adjusted OR, 1.63; 95% CI, 1.25–2.11). Tranexamic acid reduced the risk of hematoma expansion in the overall patients with ICH (adjusted OR, 0.76; 95% CI, 0.62–0.93) and antiplatelet subgroup (adjusted OR, 0.61; 95% CI, 0.41–0.91) with no significant interaction between pre‐ICH antiplatelet therapy and tranexamic acid (P interaction=0.248).

Conclusions
Antiplatelet therapy is independently associated with hematoma expansion and unfavorable functional outcome. Tranexamic acid reduced hematoma expansion regardless of prior antiplatelet therapy use.

Citation

Law, Z. K., Desborough, M., Roberts, I., Al‐Shahi Salman, R., England, T. J., Werring, D. J., Robinson, T., Krishnan, K., Dineen, R., Laska, A. C., Peters, N., Egea‐Guerrero, J. J., Karlinski, M., Christensen, H., Roffe, C., Bereczki, D., Ozturk, S., Thanabalan, J., Collins, R., Beridze, M., …Sprigg, N. (2021). Outcomes in Antiplatelet‐Associated Intracerebral Hemorrhage in the TICH‐2 Randomized Controlled Trial. Journal of the American Heart Association, 10(5), Article e019130. https://doi.org/10.1161/jaha.120.019130

• Journal Article Type: Article
• Acceptance Date: Jan 10, 2021
• Online Publication Date: Feb 15, 2021
• Publication Date: Mar 2, 2021
• Deposit Date: Feb 22, 2021
• Publicly Available Date: Feb 22, 2021
• Journal: Journal of the American Heart Association
• Electronic ISSN: 2047-9980
• Publisher: Wiley Open Access
• Peer Reviewed: Peer Reviewed
• Volume: 10
• Issue: 5
• Article Number: e019130
• DOI: https://doi.org/10.1161/jaha.120.019130
• Keywords: Cardiology and Cardiovascular Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/5335429
• Publisher URL: https://www.ahajournals.org/doi/10.1161/JAHA.120.019130