Aspirin Use and the Risk of Symptomatic Hemorrhage in Patients With Cerebral Cavernous Malformations and Ischemic Cerebrovascular Disease.

Abstract

Background: Cerebral cavernous malformations (CCMs) are a common cause of spontaneous intracerebral hemorrhage (ICH). However, the association of aspirin with the hemorrhage risk of CCMs remains unclear.

Methods: This retrospective study consecutively enrolled patients with CCMs and asymptomatic or symptomatic ischemic cerebrovascular disease between March 2015 and July 2024. Baseline and follow-up information, including ICH presentation and aspirin use, were recorded. The primary outcome was a CCM-related hemorrhage event, defined as the onset of any new or worsened clinical symptoms caused by overt ICH, confirmed by radiological evidence. Independent factors of symptomatic hemorrhage were analyzed using Cox regression before and after 1:1 propensity score matching.

Results: Among 259 patients with untreated CCMs, 129 (49.8%) patients took aspirin daily. Over a total follow-up time of 793.0 person-years, new clinical hemorrhage events occurred in 30 (11.6%) patients, including 27 (20.8%) in the nonaspirin group and 3 (2.3%) in the aspirin group. Multivariable Cox analysis revealed that CCM size, developmental venous anomaly, and ICH presentation were associated with a high risk of CCM hemorrhage, whereas aspirin use (hazard ratio, 0.13 [95% CI, 0.03-0.61]; P=0.010) was associated with a lower risk. In the subgroup analysis, aspirin use was associated with a significantly reduced risk of recurrent hemorrhage in patients with ICH presentation (χ ²=10.62, P=0.001). After 1:1 propensity score matching to control for size, ICH presentation, diabetes, hyperlipidemia, and statin use, CCM hemorrhage occurred in 12 (10.0%) of 120 patients, and further analysis revealed that aspirin was still associated with a low hemorrhage rate in CCMs (hazard ratio, 0.09 [95% CI, 0.01-0.70]; P=0.021).

Conclusions: Aspirin use is associated with a lower risk of symptomatic hemorrhage in patients with CCMs and ischemic cerebrovascular disease. Prospective studies are needed to validate these findings.