Table_1_Clinical Outcome in Patients With Intracerebral Hemorrhage Stratified by Type of Antithrombotic Therapy.DOCX

Background: Antithrombotic therapy influences clinical outcome after spontaneous intracerebral hemorrhage (ICH). However, evidence on the effect of different antithrombotic therapies on outcome and a comparison between different therapies is scarce, while this is important for medical decision making. Therefore, we investigated clinical outcome after ICH stratified by type of antithrombotic therapy.Patients/Methods: We performed a cohort study selecting consecutive ICH patients from our database, excluding patients without data on medication or therapeutic heparin use. Primary outcome was poor outcome (modified Rankin Scale ≥ 4) after 90 days. Secondary outcome was mortality at 90 days. We analyzed outcome and survival in patients with ICH using vitamin K antagonists (VKA), antiplatelet therapy (AP), and direct oral anticoagulant (DOAC) compared to no antithrombotic therapy adjusted for age, National Institutes of Health Stroke Scale (NIHSS), infratentorial localization, intraventricular extension, history of hypertension, diabetes, or stroke, and interaction between age and NIHSS.Results: We included 916 patients (223 AP, 161 VKA, and 40 DOAC). VKA (adjusted odds ratio [aOR] 3.2, 95% confidence interval [CI], 1.6–6.3) and AP (aOR = 2.0, 95%CI: 1.1–3.7) were associated with poor outcome. DOAC use did not reach statistical significance (aOR = 2.4, 95%CI: 0.8–7.7). Patients who used any antithrombotic therapy had poorer survival compared to patients without antithrombotic treatment and patients using AP and DOAC had better survival compared to VKA after adjustment.Conclusions: Patients with antithrombotic therapy have worse clinical outcome after ICH. Patients using VKA have higher risk of poor outcome and mortality compared to patients using AP. These findings highlight the deleterious effect of antithrombotic therapy in patients with ICH and stress the need for effective therapies for ICH patients.

背景：抗凝治疗对自发性脑出血（ICH）后的临床结果产生重要影响。然而，关于不同抗凝治疗对结果的影响以及不同治疗方法之间的比较的证据尚显匮乏，而这一点对于医疗决策至关重要。因此，本研究旨在根据抗凝治疗类型对ICH患者的临床结果进行分层研究。患者与方法：我们通过选取连续性ICH患者样本，排除无药物或治疗性肝素使用数据的患者，进行了一项队列研究。主要结局指标为90天后不良预后（改良Rankin量表≥4）。次要结局指标为90天内的死亡率。我们使用维生素K拮抗剂（VKA）、抗血小板治疗（AP）和直接口服抗凝剂（DOAC）对ICH患者的结局和生存率进行了分析，并与未接受抗凝治疗的患者以及调整年龄、美国国立卫生研究院卒中量表（NIHSS）、小脑幕下定位、脑室内延伸、高血压、糖尿病或卒中病史以及年龄与NIHSS之间的交互作用进行了比较。结果：我们纳入了916名患者（AP组223例，VKA组161例，DOAC组40例）。VKA（调整后的优势比[OR] 3.2，95%置信区间[CI] 1.6–6.3）和AP（调整后的OR = 2.0，95%CI: 1.1–3.7）与不良预后相关。DOAC的使用未达到统计学意义（调整后的OR = 2.4，95%CI: 0.8–7.7）。与未接受抗凝治疗的患者相比，使用任何抗凝治疗的患者预后较差，且在使用AP和DOAC的患者中，调整后与使用VKA的患者相比，生存率更高。结论：接受抗凝治疗的患者在ICH后临床预后较差。与使用AP的患者相比，使用VKA的患者不良预后和死亡率的风险更高。这些发现突出了抗凝治疗在ICH患者中的有害作用，并强调了为ICH患者提供有效疗法的必要性。