Introduction: In patients with intracerebral hemorrhage (ICH) who were on antiplatelet therapy (APT) and remain alive at the time of hospital discharge, clinicians are frequently faced with the decision of whether or not to restart APT. The objective of the study was to compare the functional outcomes and health-related quality of life (HRQoL) in ICH patients for whom APT was restarted versus those for whom APT was not restarted.
Methods: Subjects from the multicenter, prospective Ethnic/Racial Variations in ICH (ERICH) study who fulfilled the following inclusion criteria were included: adult (age at least 18 years) ICH patients prescribed APT before ICH and who survived to hospital discharge. The primary outcome was good functional outcome defined as modified Rankin Scale (mRS) 0–2 at 90 days. Secondary outcomes at 90 days were excellent mRS 0–1, mortality, Barthel Index, and health status (EuroQol Group 5-Dimension [EQ-5D] and EQ-5D Visual Analog Scale [VAS] scores).
Results: There were 127 patients restarted and 732 patients not restarted on APT (Figure 1). Restarting APT was associated with lower rates of good functional outcome (36.5% vs. 40.8%; adjusted OR=0.549 [0.331–0.912], p=0.021) and lower Barthel index scores at 90 days (adjusted Beta=-6.884 [-13.474–-0.294], p=0.041) (Table 1). When the two cohorts were propensity score-matched in a 1:1 ratio, each comprised 107 patients, no significant difference in primary outcome was observed between restarting vs. not restarting APT (35.5% vs. 43.9%; adjusted OR=1.622 [0.904–2.907], p=0.105) (Table 2). There were also no differences between the secondary outcomes.
Conclusions: Restarting APT in patients with ICH of mild to moderate severity after acute hospitalization is not associated with worse functional outcomes or HRQoL at 90 days. Restarting APT after acute hospitalization should be considered in ICH patients with significant cardiovascular risk factors.
Patient Care: In ICH patients who were on antiplatelet therapy (APT) and remain alive at the time of hospital discharge, clinicians are frequently faced with the decision of whether or not to restart APT. This study demonstrated that restarting APT in patients with ICH of mild to moderate severity after acute hospitalization is not associated with worse functional outcomes. Hence, restarting APT should be considered in ICH patients with significant cardiovascular risk factors.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Recognize the challenges faced by many clinicians in deciding whether to restart antiplatelet therapy in the post-ICH setting, 2) Discuss in small groups, the benefits and risks of restarting antiplatelet therapy in ICH patients, and how these may affect functional outcomes, and 3) Identify a subgroup of ICH patients in whom restarting antiplatelet therapy should be considered.