脳出血患者の予後に及ぼす抗血小板薬・抗凝固薬の影響

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Background: Intracerebral hemorrhage (ICH) associated with antiplatelet-therapy (AP) and with anticoagulant-therapy (AC) is becoming more common as the use of these medications increases in the aging population. The effect of preceding AP and AC on outcome after ICH has not been adequately investigated. We evaluated mortality and hematoma enlargement in patients with ICH to determine the influence of AP or AC on prognosis of patients with ICH.
Methods: We identified all patients hospitalized with ICH in a single center from October 2008 through September 2009 and evaluated their clinical characteristics and outcomes from hospital records.
Results: There were 156 consecutive patients with ICH, including 22 patients treated with AP and 19 with AC. Two of these patients received both AP and AC. The AP group and AC group were compared with the group of no-antiplatelet-or-anticoagulant-therapy (NT). Mortality in the AP group (36%) and AC group (42%) was higher than that in the NT group (14%). A multivariable analysis showed that AP and AC were independently associated with mortality. The initial ICH volume was greater in the AP group, and hemorrhage expansion occurred more in the AC group. Thus a higher rate of mortality was indicated in these groups. Furthermore, the rates of thrombotic events were higher in the AP group and AC group.
Conclusion: We showed poor outcomes and increased mortality in patients treated with AP and AC. Further studies will be required to identify effective treatment to prevent hemorrhage expansion and thrombotic events.