Antithrombotic medications and the etiology of intracerebral hemorrhage MUCH-Italy

作者：Pezzini Alessandro^*; Grassi Mario; Paciaroni Maurizio; Zini Andrea; Silvestrelli Giorgio; Del Zotto Elisabetta; Caso Valeria; Dell' Acqua Maria Luisa; Giossi Alessia; Volonghi Irene; Simone Anna Maria; Lanari Alessia; Costa Paolo; Poli Loris; Morotti Andrea; De Giuli Valeria; Pepe Daniele; Gamba Massimo; Ciccone Alfonso; Ritelli Marco; Colombi Marina; Agnelli Giancarlo; Padovani Alessandro

来源：Neurology, 2014, 82(6): 529-535.

DOI：10.1212/WNL.0000000000000108

Objective:To test the hypothesis that the effect of antithrombotic medications on the risk of intracerebral hemorrhage (ICH) varies according to the location of the hematoma.Methods:Consecutive patients with ICH were enrolled as part of the Multicenter Study on Cerebral Hemorrhage in Italy (MUCH-Italy). Multivariable logistic regression models served to examine whether risk factors for ICH and location of the hematoma (deep vs lobar) predict treatment-specific ICH subgroups (antiplatelets-related ICH and oral anticoagulants [OACs]-related ICH).Results:A total of 870 (313 lobar ICH, 557 deep ICH) subjects were included. Of these, 223 (25.6%) were taking antiplatelets and 77 (8.8%) OACs at the time of stroke. The odds of antiplatelet-related ICH increased with aging (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.03-1.07) and hypertension (OR 1.86; 95% CI 1.22-2.85) but had no relation with the anatomical location of ICH. Conversely, lobar location of the hematoma was associated with the subgroup of OAC-related ICH (OR 1.70; 95% CI 1.03-2.81) when compared to the subgroup of patients taking no antithrombotic medications. Within the subgroup of patients taking OACs, international normalized ratio (INR) values were higher in those with lobar ICH as compared to those with deep ICH (2.8 1.1 vs 2.2 +/- 0.8; p = 0.011). The proportion of patients with lobar hematoma increased with increasing intensity of anticoagulation, with a approximate to 2-fold increased odds of lobar compared to deep ICH (odds 2.17; p = 0.03) in those exposed to overanticoagulation (INR values %26gt;3.0).Conclusions:OACs, as opposed to antiplatelets, predispose to lobar location of brain hematomas according to a dose-response relationship.

• 出版日期2014-2-11