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Antithrombotics alter intracerebral hemorrhage presentation without affecting minimally invasive endoscopic evacuation
Intracerebral hemorrhages are associated with significant morbidity and mortality. While the ENRICH trial supports the efficacy of surgical evacuation for lobar hemorrhages, the impact of antithrombotic therapies on minimally invasive surgery outcomes remains unexplored. This study evaluates the eff...
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| Published in: | Journal of stroke and cerebrovascular diseases 2024-09, Vol.33 (9), p.107878, Article 107878 |
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| container_title | Journal of stroke and cerebrovascular diseases |
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| creator | Ezzat, Bahie Rossitto, Christina P. Kalagara, Roshini Ali, Muhammad Vasa, Devarshi Dedhia, Mehek Asfaw, Zerubabbel Arora, Arushi Schuldt, Braxton Smith, Colton Bose, Javin Mocco, J Kellner, Christopher P. |
| description | Intracerebral hemorrhages are associated with significant morbidity and mortality. While the ENRICH trial supports the efficacy of surgical evacuation for lobar hemorrhages, the impact of antithrombotic therapies on minimally invasive surgery outcomes remains unexplored. This study evaluates the effects of chronic anticoagulants and antiplatelets on the technical and longterm outcomes of minimally invasive intracerebral hemorrhage evacuation.
A prospectively collected registry of patients undergoing minimally invasive surgery for intracerebral hemorrhage from a single institution was analyzed (December 2015-September 2022). Data included key demographics, comorbidities, antithrombotic/reversal status, presenting clinical/radiographic characteristics, procedural metrics, and clinical outcomes. Patients were divided into control (neither therapy), antiplatelet-only, and anticoagulant-only groups, with antiplatelet/anticoagulant reversals conducted per current American Heart Association/American Stroke Association guidelines. Variables significant in univariate analyses (p |
| doi_str_mv | 10.1016/j.jstrokecerebrovasdis.2024.107878 |
| format | article |
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A prospectively collected registry of patients undergoing minimally invasive surgery for intracerebral hemorrhage from a single institution was analyzed (December 2015-September 2022). Data included key demographics, comorbidities, antithrombotic/reversal status, presenting clinical/radiographic characteristics, procedural metrics, and clinical outcomes. Patients were divided into control (neither therapy), antiplatelet-only, and anticoagulant-only groups, with antiplatelet/anticoagulant reversals conducted per current American Heart Association/American Stroke Association guidelines. Variables significant in univariate analyses (p<0.05) were advanced to multivariable regression models.
Among 226 intracerebral hemorrhage patients treated with minimally invasive surgery, 41% (N=93) had antithrombotic medication history; 28% (N=64) received antiplatelets, and 9% (N=21) received anticoagulants. Patients on both therapies (N=6) were excluded. The antiplatelet group presented more frequently with lobar hemorrhages (56% vs. 37%; p=0.022), while patients on anticoagulants showed increased rates of intraventricular hemorrhage co-presentation (62% vs. 46%; p=0.011) compared to controls. Despite univariate analyses showing a higher postoperative hematoma volume (3.9 vs. 2.9 milliliters; p=0.020) and lower evacuation percentage (88% vs. 92%; p=0.019) for the antiplatelet group, and longer procedures for patients on anticoagulants (2.3 vs. 1.7 hours; p=0.042) compared to control, multivariable analyses indicated that antiplatelets and anticoagulants had no significant impact on these technical outcomes. Longitudinally, antithrombotics were not associated with increased rebleeding, less frequent discharge to home, lower 30-day mortality, or worse, 6-month Modified Rankin Scale scores.
Patients on chronic antiplatelets and anticoagulants exhibited characteristic intracerebral hemorrhage phenotypes without worse technical or long-term outcomes after minimally invasive intracerebral hemorrhage evacuation, suggesting the procedure's safety for these patients.</description><identifier>ISSN: 1052-3057</identifier><identifier>ISSN: 1532-8511</identifier><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2024.107878</identifier><identifier>PMID: 39025249</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Anticoagulants ; Anticoagulants - administration & dosage ; Anticoagulants - adverse effects ; Anticoagulants - therapeutic use ; Antiplatelets ; Antithrombotic therapy ; Cerebral Hemorrhage - diagnostic imaging ; Cerebral Hemorrhage - drug therapy ; Cerebral Hemorrhage - mortality ; Cerebral Hemorrhage - surgery ; Female ; Fibrinolytic Agents - administration & dosage ; Fibrinolytic Agents - adverse effects ; Humans ; Intracerebral hemorrhage ; Male ; Middle Aged ; Minimally invasive surgery ; Neuroendoscopy - adverse effects ; Platelet Aggregation Inhibitors - adverse effects ; Platelet Aggregation Inhibitors - therapeutic use ; Registries ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome</subject><ispartof>Journal of stroke and cerebrovascular diseases, 2024-09, Vol.33 (9), p.107878, Article 107878</ispartof><rights>2024</rights><rights>Copyright © 2024. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c269t-a4d0700f7b600e4e8cbc00d1e4996e1c05a84aaa7621404060daccc02f750e293</cites><orcidid>0000-0001-9729-9122</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39025249$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ezzat, Bahie</creatorcontrib><creatorcontrib>Rossitto, Christina P.</creatorcontrib><creatorcontrib>Kalagara, Roshini</creatorcontrib><creatorcontrib>Ali, Muhammad</creatorcontrib><creatorcontrib>Vasa, Devarshi</creatorcontrib><creatorcontrib>Dedhia, Mehek</creatorcontrib><creatorcontrib>Asfaw, Zerubabbel</creatorcontrib><creatorcontrib>Arora, Arushi</creatorcontrib><creatorcontrib>Schuldt, Braxton</creatorcontrib><creatorcontrib>Smith, Colton</creatorcontrib><creatorcontrib>Bose, Javin</creatorcontrib><creatorcontrib>Mocco, J</creatorcontrib><creatorcontrib>Kellner, Christopher P.</creatorcontrib><title>Antithrombotics alter intracerebral hemorrhage presentation without affecting minimally invasive endoscopic evacuation</title><title>Journal of stroke and cerebrovascular diseases</title><addtitle>J Stroke Cerebrovasc Dis</addtitle><description>Intracerebral hemorrhages are associated with significant morbidity and mortality. While the ENRICH trial supports the efficacy of surgical evacuation for lobar hemorrhages, the impact of antithrombotic therapies on minimally invasive surgery outcomes remains unexplored. This study evaluates the effects of chronic anticoagulants and antiplatelets on the technical and longterm outcomes of minimally invasive intracerebral hemorrhage evacuation.
A prospectively collected registry of patients undergoing minimally invasive surgery for intracerebral hemorrhage from a single institution was analyzed (December 2015-September 2022). Data included key demographics, comorbidities, antithrombotic/reversal status, presenting clinical/radiographic characteristics, procedural metrics, and clinical outcomes. Patients were divided into control (neither therapy), antiplatelet-only, and anticoagulant-only groups, with antiplatelet/anticoagulant reversals conducted per current American Heart Association/American Stroke Association guidelines. Variables significant in univariate analyses (p<0.05) were advanced to multivariable regression models.
Among 226 intracerebral hemorrhage patients treated with minimally invasive surgery, 41% (N=93) had antithrombotic medication history; 28% (N=64) received antiplatelets, and 9% (N=21) received anticoagulants. Patients on both therapies (N=6) were excluded. The antiplatelet group presented more frequently with lobar hemorrhages (56% vs. 37%; p=0.022), while patients on anticoagulants showed increased rates of intraventricular hemorrhage co-presentation (62% vs. 46%; p=0.011) compared to controls. Despite univariate analyses showing a higher postoperative hematoma volume (3.9 vs. 2.9 milliliters; p=0.020) and lower evacuation percentage (88% vs. 92%; p=0.019) for the antiplatelet group, and longer procedures for patients on anticoagulants (2.3 vs. 1.7 hours; p=0.042) compared to control, multivariable analyses indicated that antiplatelets and anticoagulants had no significant impact on these technical outcomes. Longitudinally, antithrombotics were not associated with increased rebleeding, less frequent discharge to home, lower 30-day mortality, or worse, 6-month Modified Rankin Scale scores.
Patients on chronic antiplatelets and anticoagulants exhibited characteristic intracerebral hemorrhage phenotypes without worse technical or long-term outcomes after minimally invasive intracerebral hemorrhage evacuation, suggesting the procedure's safety for these patients.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants</subject><subject>Anticoagulants - administration & dosage</subject><subject>Anticoagulants - adverse effects</subject><subject>Anticoagulants - therapeutic use</subject><subject>Antiplatelets</subject><subject>Antithrombotic therapy</subject><subject>Cerebral Hemorrhage - diagnostic imaging</subject><subject>Cerebral Hemorrhage - drug therapy</subject><subject>Cerebral Hemorrhage - mortality</subject><subject>Cerebral Hemorrhage - surgery</subject><subject>Female</subject><subject>Fibrinolytic Agents - administration & dosage</subject><subject>Fibrinolytic Agents - adverse effects</subject><subject>Humans</subject><subject>Intracerebral hemorrhage</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Minimally invasive surgery</subject><subject>Neuroendoscopy - adverse effects</subject><subject>Platelet Aggregation Inhibitors - adverse effects</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1052-3057</issn><issn>1532-8511</issn><issn>1532-8511</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNqVkE1P3DAQhq2qqFDoX6h8RJWyjB07H0eKKFRaiQucLceZsN4m9mI7qfj3NQ1w6qUnz-GZ9_U8hHxjsGHAqov9Zh9T8L_QYMAu-EXH3sYNBy4yUDd184GcMFnyopGMfcwzSF6UIOtj8jnGPQBjspGfyHHZApdctCdkuXTJpl3wU-eTNZHqMWGg1qWg1xo90h1OPoSdfkR6CBjRJZ2sd_R33vRzonoY0CTrHulknZ30OD7nhPw9uyBF1_to_MEaios289_VM3I06DHil9f3lDz8uL6_ui22dzc_ry63heFVmwoteqgBhrqrAFBgYzoD0DMUbVshMyB1I7TWdcWZAAEV9NoYA3yoJSBvy1NyvuYegn-aMSY12WhwHLVDP0dVQsMrXgtZZfT7iprgYww4qEPIt4RnxUC9-Fd79S__6sW_Wv3nkK-vfXM3Yf8e8SY8A9sVwHz1YjGoaCw6g70N2aHqvf2fvj-J0Klv</recordid><startdate>202409</startdate><enddate>202409</enddate><creator>Ezzat, Bahie</creator><creator>Rossitto, Christina P.</creator><creator>Kalagara, Roshini</creator><creator>Ali, Muhammad</creator><creator>Vasa, Devarshi</creator><creator>Dedhia, Mehek</creator><creator>Asfaw, Zerubabbel</creator><creator>Arora, Arushi</creator><creator>Schuldt, Braxton</creator><creator>Smith, Colton</creator><creator>Bose, Javin</creator><creator>Mocco, J</creator><creator>Kellner, Christopher P.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9729-9122</orcidid></search><sort><creationdate>202409</creationdate><title>Antithrombotics alter intracerebral hemorrhage presentation without affecting minimally invasive endoscopic evacuation</title><author>Ezzat, Bahie ; 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While the ENRICH trial supports the efficacy of surgical evacuation for lobar hemorrhages, the impact of antithrombotic therapies on minimally invasive surgery outcomes remains unexplored. This study evaluates the effects of chronic anticoagulants and antiplatelets on the technical and longterm outcomes of minimally invasive intracerebral hemorrhage evacuation.
A prospectively collected registry of patients undergoing minimally invasive surgery for intracerebral hemorrhage from a single institution was analyzed (December 2015-September 2022). Data included key demographics, comorbidities, antithrombotic/reversal status, presenting clinical/radiographic characteristics, procedural metrics, and clinical outcomes. Patients were divided into control (neither therapy), antiplatelet-only, and anticoagulant-only groups, with antiplatelet/anticoagulant reversals conducted per current American Heart Association/American Stroke Association guidelines. Variables significant in univariate analyses (p<0.05) were advanced to multivariable regression models.
Among 226 intracerebral hemorrhage patients treated with minimally invasive surgery, 41% (N=93) had antithrombotic medication history; 28% (N=64) received antiplatelets, and 9% (N=21) received anticoagulants. Patients on both therapies (N=6) were excluded. The antiplatelet group presented more frequently with lobar hemorrhages (56% vs. 37%; p=0.022), while patients on anticoagulants showed increased rates of intraventricular hemorrhage co-presentation (62% vs. 46%; p=0.011) compared to controls. Despite univariate analyses showing a higher postoperative hematoma volume (3.9 vs. 2.9 milliliters; p=0.020) and lower evacuation percentage (88% vs. 92%; p=0.019) for the antiplatelet group, and longer procedures for patients on anticoagulants (2.3 vs. 1.7 hours; p=0.042) compared to control, multivariable analyses indicated that antiplatelets and anticoagulants had no significant impact on these technical outcomes. Longitudinally, antithrombotics were not associated with increased rebleeding, less frequent discharge to home, lower 30-day mortality, or worse, 6-month Modified Rankin Scale scores.
Patients on chronic antiplatelets and anticoagulants exhibited characteristic intracerebral hemorrhage phenotypes without worse technical or long-term outcomes after minimally invasive intracerebral hemorrhage evacuation, suggesting the procedure's safety for these patients.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>39025249</pmid><doi>10.1016/j.jstrokecerebrovasdis.2024.107878</doi><orcidid>https://orcid.org/0000-0001-9729-9122</orcidid></addata></record> |
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| subjects | Aged Aged, 80 and over Anticoagulants Anticoagulants - administration & dosage Anticoagulants - adverse effects Anticoagulants - therapeutic use Antiplatelets Antithrombotic therapy Cerebral Hemorrhage - diagnostic imaging Cerebral Hemorrhage - drug therapy Cerebral Hemorrhage - mortality Cerebral Hemorrhage - surgery Female Fibrinolytic Agents - administration & dosage Fibrinolytic Agents - adverse effects Humans Intracerebral hemorrhage Male Middle Aged Minimally invasive surgery Neuroendoscopy - adverse effects Platelet Aggregation Inhibitors - adverse effects Platelet Aggregation Inhibitors - therapeutic use Registries Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome |
| title | Antithrombotics alter intracerebral hemorrhage presentation without affecting minimally invasive endoscopic evacuation |
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