In-Hospital Aspirin Dose as a Risk Factor for Hemorrhagic Transformation in Patients Not Treated With Thrombolysis.

IF 1.1 4区医学 Q4 CLINICAL NEUROLOGY

Neurologist Pub Date : 2023-09-01 DOI:10.1097/NRL.0000000000000486

Joao Brainer Clares de Andrade, Jay P Mohr, Fabricio Oliveira Lima, Joao José Freitas de Carvalho, Levi Coelho Maia Barros, Octavio Marques Pontes-Neto, Gabriel Queiroz de Abreu, Gisele Sampaio Silva

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引用次数: 0

Abstract

Background: Aspirin is widely used as secondary prophylaxis for acute ischemic stroke. However, its influence on the risk of spontaneous hemorrhagic transformation (HT) is still unclear. Predictive scores of HT have been proposed. We hypothesized that an increased aspirin dose might be harmful in patients at a high risk of HT. This study aimed to analyze the relationship between in-hospital daily aspirin dose (IAD) and HT in patients with acute ischemic stroke.

Methods: We conducted a retrospective cohort study of patients admitted to our comprehensive stroke center between 2015 and 2017. The attending team defined IAD. All included patients underwent either computed tomography or magnetic resonance imaging within 7 days of admission. The risk of HT was assessed using the predictive score of HT in patients not undergoing reperfusion therapies. Regression models were used to evaluate the correlations between HT and IAD.

Results: A total of 986 patients were included in the final analysis. The prevalence of HT was 19.2%, and parenchymatous hematomas type-2 (PH-2) represented 10% (n=19) of these cases. IAD was not associated with HT ( P =0.09) or PH-2 ( P =0.06) among all patients. However, in patients at a higher risk for HT (patients not undergoing reperfusion therapies ≥3), IAD was associated with PH-2 (odds ratio 1.01,95% CI 1.001-1.023, P =0.03) in an adjusted analysis. Taking 200 versus 300 mg aspirin was protective against PH-2 (odds ratio 0.102, 95% CI 0.018-0.563, P =0.009).

Conclusion: An increased in-hospital aspirin dose is associated with intracerebral hematoma in patients at a high risk of HT. Stratifying the risk of HT may lead to individualized daily aspirin dose choices. However, clinical trials on this topic are required.

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未接受溶栓治疗的患者出血转化的危险因素——住院阿司匹林剂量。

背景：阿司匹林被广泛用于急性缺血性脑卒中的二级预防。然而，其对自发性出血性转化（HT）风险的影响尚不清楚。已经提出了HT的预测分数。我们假设增加阿司匹林剂量可能对HT高危患者有害。本研究旨在分析急性缺血性卒中患者住院每日阿司匹林剂量（IAD）与HT之间的关系。方法：我们对2015年至2017年间入住我们综合中风中心的患者进行了回顾性队列研究。与会团队定义了IAD。所有纳入的患者均在入院后7天内接受了计算机断层扫描或磁共振成像。在未接受再灌注治疗的患者中，使用HT的预测评分来评估HT的风险。采用回归模型评估HT与IAD的相关性。结果：共有986名患者被纳入最终分析。HT的患病率为19.2%，2型实质性血肿（PH-2）占这些病例的10%（n=19）。在所有患者中，IAD与HT（P=0.09）或PH-2（P=0.06）无关。然而，在HT风险较高的患者（未接受再灌注治疗的患者≥3）中，在一项调整后的分析中，IAD与PH-2相关（比值比1.01,95%CI 1.001-1.023，P=0.03）。服用200mg和300mg阿司匹林对PH-2具有保护作用（比值比0.102，95%CI 0.018-0.563，P=0.009）。结论：在HT高危患者中，增加住院阿司匹林剂量与脑内血肿有关。将HT风险分层可能导致个性化的每日阿司匹林剂量选择。然而，还需要对这一主题进行临床试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurologist 医学-临床神经学

CiteScore

1.90

自引率

0.00%

发文量

151

审稿时长

2 months

期刊介绍： The Neurologist publishes articles on topics of current interest to physicians treating patients with neurological diseases. The core of the journal is review articles focusing on clinically relevant issues. The journal also publishes case reports or case series which review the literature and put observations in perspective, as well as letters to the editor. Special features include the popular "10 Most Commonly Asked Questions" and the "Patient and Family Fact Sheet," a handy tear-out page that can be copied to hand out to patients and their caregivers.