The role of reduced platelet function in postoperative intracranial bleeding among supratentorial severe spontaneous intracerebral hemorrhage patients on long-term antiplatelet therapy.

Objective: Patients with severe spontaneous intracerebral hemorrhage on long-term oral antiplatelet therapy (SSICH-LOAPT) may be at high risk of postoperative intracranial bleeding (PIB). The effect of reduced platelet function (RPF) on PIB is unclear. This study aimed to investigate the relationship between RPF and PIB in patients with supratentorial SSICH-LOAPT and explore factors for risk stratification to predict PIB.

Methods: The supratentorial SSICH-LOAPT patients receiving surgery were enrolled from a multicenter prospective cohort study. Preoperative platelet function was measured using thromboelastography and was categorized as RPF (kaolin maximum amplitude [CK-MA] < 50 mm) or non-RPF. The primary outcome was PIB within 7 days after surgery. The risk of PIB in RPF and non-RPF patients was compared.

Results: This study included 172 supratentorial SSICH-LOAPT patients (126 male patients, median age 56 years). PIB occurred in 25 (14.5%) patients, and 6 (3.5%) patients experienced severe PIB, which required repeat surgery. Eighteen (10.5%) patients were identified as having RPF. Kaplan-Meier analysis revealed that patients with RPF exhibited a higher incidence of PIB compared with non-RPF patients (61.1% vs 9.1%, p < 0.001). After adjusting for age, intracerebral hemorrhage history, antiplatelet therapy regimen, coagulation dysfunction, and hematoma volume, RPF was independently associated with postoperative rebleeding (hazard ratio 5.24, 95% CI 1.29-21.33; p = 0.021). Patients who developed severe PIB had significantly lower CK-MA values (median 33.9 mm) compared to those with nonsevere PIB (median 50.2 mm) (p = 0.001).

Conclusions: RPF was a risk factor related to PIB for supratentorial SSICH-LOAPT patients. Clinical trial registration no.: ChiCTR1900024406 (www.chictr.org.cn).