Andrea Morotti, Jawed Nawabi, Qi Li, Maddalena Toffali, Andrea Dell'Orco, Francesco Berinato, Federico Mazzacane, Giorgio Busto, Anna Cavallini, Eugenio Magni, Maurizio Paciaroni, Michele Laudisi, Ilaria Casetta, Raffaele Ornello, Francesca Gabriele, Matteo Paolucci, Stefano Forlivesi, Alessandro Marè, Giovanni Merlino, Enrico Fainardi, Andrea Zini, Alessandro Padovani
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The main outcomes of the analysis were HE (hemorrhage growth > 33% and/or > 6 mL) and poor prognosis at 3 months (modified Rankin Scale 4-6). To account for potential confounders we calculated every patients' predicted probability of the outcome of interest, using logistic regression estimates and summarizing the predicted probability as a continuous variable ranging from 0 to 1.</p><p><strong>Results: </strong>A total of 1644 patients were included, of whom 463 (28.2%) were on SAPT and 25 (1.5%) on DAPT (aspirin plus clopidogrel). DAPT-associated ICH had the highest risk of HE (expressed as mean predicted probability (95% confidence interval, CI): NAPT 0.23 (95% CI 0.23-0.24), SAPT 0.31 (95% CI 0.30-0.32), DAPT 0.42 (95% CI 0.35-0.49), p < 0.001. DAPT patients had also the highest risk of poor outcome: NAPT 0.48 (95% CI 0.47-0.50), SAPT 0.55 (95% CI 0.52.0.57), DAPT 0.70 (95% CI 0.60-0.79), p < 0.001. Among patients on SAPT, the comparison between ICH associated with aspirin (n = 420) and clopidogrel (n = 43) showed similar rates of HE, and poor outcome (all p > 0.1).</p><p><strong>Conclusion: </strong>DAPT is associated with higher risk of HE and poor outcome in acute ICH. These findings might inform clinical practice and future trials.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 9","pages":"601"},"PeriodicalIF":4.6000,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Characteristics of intracerebral hemorrhage associated with dual antiplatelet treatment.\",\"authors\":\"Andrea Morotti, Jawed Nawabi, Qi Li, Maddalena Toffali, Andrea Dell'Orco, Francesco Berinato, Federico Mazzacane, Giorgio Busto, Anna Cavallini, Eugenio Magni, Maurizio Paciaroni, Michele Laudisi, Ilaria Casetta, Raffaele Ornello, Francesca Gabriele, Matteo Paolucci, Stefano Forlivesi, Alessandro Marè, Giovanni Merlino, Enrico Fainardi, Andrea Zini, Alessandro Padovani\",\"doi\":\"10.1007/s00415-025-13339-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Antiplatelet treatment is associated with hematoma expansion (HE) and poor outcome in intracerebral hemorrhage (ICH). We aimed to describe the characteristics of ICH associated with dual antiplatelet treatment (DAPT), compared with single (SAPT) and no antiplatelet treatment (NAPT).</p><p><strong>Methods: </strong>A retrospective analysis of ICH patients admitted at nine academic stroke centers in Italy, Germany, and China was conducted. The main outcomes of the analysis were HE (hemorrhage growth > 33% and/or > 6 mL) and poor prognosis at 3 months (modified Rankin Scale 4-6). To account for potential confounders we calculated every patients' predicted probability of the outcome of interest, using logistic regression estimates and summarizing the predicted probability as a continuous variable ranging from 0 to 1.</p><p><strong>Results: </strong>A total of 1644 patients were included, of whom 463 (28.2%) were on SAPT and 25 (1.5%) on DAPT (aspirin plus clopidogrel). DAPT-associated ICH had the highest risk of HE (expressed as mean predicted probability (95% confidence interval, CI): NAPT 0.23 (95% CI 0.23-0.24), SAPT 0.31 (95% CI 0.30-0.32), DAPT 0.42 (95% CI 0.35-0.49), p < 0.001. DAPT patients had also the highest risk of poor outcome: NAPT 0.48 (95% CI 0.47-0.50), SAPT 0.55 (95% CI 0.52.0.57), DAPT 0.70 (95% CI 0.60-0.79), p < 0.001. Among patients on SAPT, the comparison between ICH associated with aspirin (n = 420) and clopidogrel (n = 43) showed similar rates of HE, and poor outcome (all p > 0.1).</p><p><strong>Conclusion: </strong>DAPT is associated with higher risk of HE and poor outcome in acute ICH. 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引用次数: 0
摘要
背景：抗血小板治疗与血肿扩张（HE）和脑出血（ICH）预后不良相关。我们的目的是描述脑出血与双重抗血小板治疗（DAPT）相关的特征，与单一（SAPT）和无抗血小板治疗（NAPT）相比。方法：回顾性分析意大利、德国和中国9个脑卒中学术中心收治的脑出血患者。分析的主要结果为HE（出血生长> 33%和/或> 6 mL）和3个月预后不良（改良Rankin评分4-6）。为了考虑潜在的混杂因素，我们使用逻辑回归估计并将预测概率汇总为0到1的连续变量，计算了每个患者预期结果的概率。结果：共纳入1644例患者，其中463例（28.2%）使用SAPT， 25例（1.5%）使用DAPT（阿司匹林加氯吡格雷）。DAPT相关性脑出血发生HE的风险最高(以平均预测概率表示（95%置信区间，CI）： NAPT 0.23 (95% CI 0.23-0.24), SAPT 0.31 （95% CI 0.30-0.32), DAPT 0.42 (95% CI 0.35-0.49), p 0.1）。结论：DAPT与急性脑出血患者高HE风险和不良预后相关。这些发现可能为临床实践和未来的试验提供信息。
Characteristics of intracerebral hemorrhage associated with dual antiplatelet treatment.
Background: Antiplatelet treatment is associated with hematoma expansion (HE) and poor outcome in intracerebral hemorrhage (ICH). We aimed to describe the characteristics of ICH associated with dual antiplatelet treatment (DAPT), compared with single (SAPT) and no antiplatelet treatment (NAPT).
Methods: A retrospective analysis of ICH patients admitted at nine academic stroke centers in Italy, Germany, and China was conducted. The main outcomes of the analysis were HE (hemorrhage growth > 33% and/or > 6 mL) and poor prognosis at 3 months (modified Rankin Scale 4-6). To account for potential confounders we calculated every patients' predicted probability of the outcome of interest, using logistic regression estimates and summarizing the predicted probability as a continuous variable ranging from 0 to 1.
Results: A total of 1644 patients were included, of whom 463 (28.2%) were on SAPT and 25 (1.5%) on DAPT (aspirin plus clopidogrel). DAPT-associated ICH had the highest risk of HE (expressed as mean predicted probability (95% confidence interval, CI): NAPT 0.23 (95% CI 0.23-0.24), SAPT 0.31 (95% CI 0.30-0.32), DAPT 0.42 (95% CI 0.35-0.49), p < 0.001. DAPT patients had also the highest risk of poor outcome: NAPT 0.48 (95% CI 0.47-0.50), SAPT 0.55 (95% CI 0.52.0.57), DAPT 0.70 (95% CI 0.60-0.79), p < 0.001. Among patients on SAPT, the comparison between ICH associated with aspirin (n = 420) and clopidogrel (n = 43) showed similar rates of HE, and poor outcome (all p > 0.1).
Conclusion: DAPT is associated with higher risk of HE and poor outcome in acute ICH. These findings might inform clinical practice and future trials.
期刊介绍：
The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field.
In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials.
Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.
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