Analysis of hemorrhage volumes after angiogram-negative subarachnoid hemorrhage

• Published in: World neurosurgery 2016-10, Vol.94, p.453-457
• Main Authors: Bray, David P., M.D, Ellis, Jason A., M.D, Lavine, Sean D., M.D, Meyers, Philip M., M.D, Connolly, E. Sander, M.D
• Format: Article
• Language: English
• Subjects: Aneurysm; Aspirin; Cerebral Angiography - statistics & numerical data; Clopidogrel; Computed Tomography Angiography - statistics & numerical data; Drug-Related Side Effects and Adverse Reactions - epidemiology; Female; Humans; Intracranial hemorrhage; Male; Middle Aged; Neurosurgery; New York - epidemiology; Platelet Aggregation Inhibitors - therapeutic use; Prevalence; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Stroke; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - epidemiology
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.07.019

Background Antiplatelet medication use is associated with worsened outcome after angiogram-negative subarachnoid hemorrhage (SAH). It has been hypothesized that these worsened outcomes may be the result of an association between antiplatelet medication use and increased hemorrhage volumes after angiogram-negative SAH. To test this hypothesis, we performed volumetric analysis of CT-defined hemorrhage after angiogram-negative SAH. Methods A retrospective analysis of patients presenting with non-traumatic, angiogram-negative SAH in the Columbia University Subarachnoid Hemorrhage Outcomes database from 2000 to 2013 was performed. Subarachnoid hemorrhage volumes on admission head CT scans were measured using MIPAV software package (version 7.20; National Institutes of Health) in a semi-automated fashion. Results A total of 108 presenting CT scans from patients with angiogram-negative SAH were analyzed. In patients with a history of antiplatelet medication use, the mean hemorrhage volume was 14.3 mL. Patients who did not have a history of antiplatelet use had a mean hemorrhage volume of 6.8 mL. This difference was found to be significant (p = 0.0029). Conclusions Antiplatelet medication use is associated with increased subarachnoid hemorrhage volumes in patients with angiogram-negative SAH. Increased hemorrhage volumes may contribute to poor outcomes in this patient population. Prospective studies are warranted to confirm this association.