Introduction: Delayed cerebral ischemia (DCI) is a serious complication of aneurysmal subarachnoid hemorrhage (aSAH), and a major predictor of poor functional outcomes in patients surviving the initial insult. Several theories have been postulated to explain the nature of this complication including platelet activation, microthrombi formation, and subsequent vasospasm. We, therefore, sought to assess the effect of on-admission antiplatelets medications on discharge functional outcomes in patients presenting with aSAH.
Methods: We conducted a retrospective comparative analysis of patients admitted to a single US center with aSAH from 2007 to 2017. Patients were included if their medications’ status on admission was available. Patients with history of antiplatelet medication intake before aSAH onset were then matched by using nearest neighbor propensity score matching (PSM) controlling for the following variables: age, hypertension, and severe Glasgow Coma Scale (GCS). STATA 14 was used for statistical analyses, using p-values <0.05 for significance.
Results: Out of the 269 patients identified for this cohort, 40 patients (14.8%) were on antiplatelets when admitted (38 on ASA, 1 on ASA+Dipyridamole, and 1 on ASA+Clopidogrel), while 229 patients (85.2%) were not. On univariate analysis, patients on antiplatelets were older (p <0.001), and more likely to be hypertensive (p <0.006). The PSM resulted in 24 patients in the antiplatelets group and 24 patients in the control group. Before matching, modified Rankin Scale (mRS) at discharge was significantly worse for patients on antiplatelets compared to those who were not (mRS 3-6 in 57.5% vs 32%; p?0.002). After matching, no significant difference was found in discharge mRS between the two groups (mRS 3-6 in 54.2% vs 45.8%; p?0.56).
Conclusions: This study did not identify any significant effect of antiplatelet medication intake before aSAH onset on discharge functional outcomes. Further research is warranted to elucidate the role of antiplatelets in aSAH.
Patient Care: Studying how commonly prescribed medications like antiplatelets affect patients admitted with subarachnoid hemorrhage could help improve clinical care through optimization of their medications. We used a propensity score matching analysis to match the two groups in order to be able to detect any differences antiplatelets may have on discharge outcomes.
Learning Objectives: Evaluate the effect of antiplatelets intake on discharge functional outcomes in patients with aneurysmal subarachnoid hemorrhage.