Antiplatelet Therapy after Intracerebral Hemorrhage and Subsequent Clinical Events: A 12-Year South Korean Cohort Study

Abstract

Introduction: Antiplatelet agents are usually discontinued to reduce hemorrhagic tendency during the acute phase of intracerebral hemorrhage (ICH). However, their use after ICH remains controversial.

Methods: This study investigated the effect of antiplatelet agents in ICH survivors. We used the National Health Insurance Service-National Sample Cohort 2002-2013 database for retrospective cohort modeling, estimating the effects of antiplatelet therapy on clinical events. Subgroup analyses assessed antiplatelet medication administered before ICH.

Results: The prescription rate of antiplatelets after ICH was also examined. Of 1,007 ICH-surviving patients, 303 subsequent clinical events were recorded, 41 recurrences of nonfatal ICH recurrence, 26 incidents of nonfatal ischemic stroke, 6 nonfatal myocardial infarctions, and 230 incidents of all-cause mortality. The use of antiplatelet therapy significantly decreased the risk of primary outcomes (adjusted hazard ratio [AHR] = 0.743, 95% confidence interval [CI] = 0.578-0.956) and all-cause mortality (AHR = 0.740, 95% CI = 0.552-0.991), especially in patients without a history of antiplatelet treatment. The use of antiplatelet medication after ICH did not significantly increase the recurrence of ICH. The prescription rate of antiplatelet therapy within 1 year was 16.6%. Among 220 patients with a history of using antiplatelet medication, the resumption rate was 0.5% at discharge, 5% after a month, 12.7% after 3 months, and 29.1% after a year.

Conclusion: Using antiplatelet treatment after ICH does not increase chances of recurrence, but lowers the occurrence of subsequent clinical events, especially mortality. However, the prescription and resumption rate of antiplatelet therapy after ICH remains low in South Korea.