Effects of Non-Aspirin Nonsteroidal Anti-Inflammatory Drugs on Acute Intracerebral Hemorrhage.

Abstract

Objective: Despite celecoxib, a cyclooxygenase-2 inhibitor, promoting functional recovery from intracerebral hemorrhage (ICH) by reducing inflammation-mediated perihematomal edema in rat models, the evidence of its effects on patient outcomes remains limited. As nonsteroidal anti-inflammatory drugs (NSAIDs) alleviate inflammation by inhibiting cyclooxygenase-2, this study aimed to assess the impact of non-aspirin NSAIDs on ICH outcomes.

Methods: Patients with acute ICH admitted to our hospital between January 2015 and December 2020 were prospectively enrolled and retrospectively categorized based on pre- or post-ICH use of non-aspirin NSAIDs. Outcomes were assessed using the modified Rankin Scale (mRS) score at 3 months, survival at 1 year, and mortality at long-term follow-up.

Results: Among 976 patients with acute ICH, 2.0% and 15.0% were non-aspirin NSAID users before and after ICH, respectively. Post-ICH non-aspirin NSAID use was associated with a reduced 1-year mortality risk (adjusted odds ratio [aOR] 0.30, p = 0.001) and long-term mortality risk (adjusted hazard ratio 0.56, p = 0.043), but not good functional outcomes (mRS 0-2) (aOR 0.98, p = 0.940). In the subgroup analyses, post-ICH use might be linked to good functional outcomes in patients with lobar hemorrhage or in those without surgical intervention. Pre-ICH non-aspirin NSAID use was not associated with these outcomes in the overall population, but it might be linked to increased mortality in subgroups with lobar hemorrhage, cerebral amyloid angiopathy, hyperlipidemia, or without intraventricular hemorrhage.

Interpretation: The post-ICH use of non-aspirin NSAIDs reduced mortality. Future studies are warranted to identify specific non-aspirin NSAID regimens that can significantly improve the outcomes of patients with ICH.