Effect of restarting antiplatelet therapy on clinical outcomes in elderly male patients with intracranial hemorrhage
Received:March 25, 2022  
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DOI:10.11915/j.issn.1671-5403.2022.09.139
Key words:aged  intracranial hemorrhage  restart antiplatelet therapy  ischemic vascular events  recurrent intracranial hemorrhage  all-cause death  vascular death This work was supported by the National Key Research and Development Program of China
Author NameAffiliationE-mail
ZHU Zi-Fan Department of Cardiology, Second Medical Center,Beijing 100853, China
Yangfangdian Outpatient Department, Southern Medical Branch, Chinese PLA General Hospital, Beijing 100853, China
National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
Chinese PLA Medical School, Beijing 100853, China 
liuhbcad301@163.comeffect 
CHEN Jian-Qiao Department of Cardiology, Second Medical Center,Beijing 100853, China liuhbcad301@163.comeffect 
SHI Xue-Zhi Yangfangdian Outpatient Department, Southern Medical Branch, Chinese PLA General Hospital, Beijing 100853, China liuhbcad301@163.comeffect 
LI Yue-Rui Department of Cardiology, Second Medical Center,Beijing 100853, China liuhbcad301@163.comeffect 
LI Yi Department of Cardiology, Second Medical Center,Beijing 100853, China
Yangfangdian Outpatient Department, Southern Medical Branch, Chinese PLA General Hospital, Beijing 100853, China
National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
Chinese PLA Medical School, Beijing 100853, China 
liuhbcad301@163.comeffect 
ZHENG Jin Department of Cardiology, Second Medical Center,Beijing 100853, China liuhbcad301@163.comeffect 
LIU Hong-Bin Department of Cardiology, Second Medical Center,Beijing 100853, China liuhbcad301@163.comeffect 
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Abstract:
      Objective To investigate the effect of restarting antiplatelet therapy on clinical outcomes in elderly male patients with intracranial hemorrhage (ICH). Methods Clinical data of 113 elderly male ICH patients admitted in the Second Medical Center of Chinese PLA General Hospital from January 2006 to December 2021 were collected and retrospectively analyzed. According to whether antiplatelet therapy was restarted, they were divided into restart antiplatelet group (Re-AP, n=67) and non-restart antiplatelet group (Non-AP, n=46). Their baseline data and clinical outcomes (ischemic vascular events, recurrent ICH, all-cause death, and vascular death) were recorded. SPSS statistics 26.0 was used for data analysis. Depending on the data types, student′s t test, Mann-Whitney U test, Chi-square test, or Fisher′s exact test was employed for comparison between groups. Univariate and multivariate Cox proportional hazards regression models were applied to analyze the risk factors for clinical outcome events. Results The Re-AP group had larger proportions of atrial fibrillation and statin use, and lower ratio of lobar hemorrhage and lower serum creatinine level than the Non-AP group. The median time to restart antiplatelet therapy was 178 (46,780) d. Multivariate Cox regression analysis showed that restarting antiplatelet therapy was independently associated with a reduced risk of ischemic vascular events (HR=0.377,95%CI 0.160-0.888; P=0.026), but not associated with an increased risk of recurrent ICH (HR=1.563,95%CI 0.767-3.184; P=0.219), all-cause mortality (HR=0.734,95%CI 0.404-1.336; P=0.312) or vascular death (HR=0.454,95%CI 0.159-1.293; P=0.139). Age and elevated creatinine level were independent risk factors for all-cause mortality (HR=1.100,95%CI 1.048-1.155; P=0.000; HR=1.009, 95%CI 1.005-1.014; P=0.000), and elevated serum creatinine level was an independent risk factor for vascular death (HR=1.009, 95%CI 1.001-1.017; P=0.028). Conclusion In elderly male patients with ICH, restarting antiplatelet therapy after a median time of 178 d reduces the risk of ischemic vascular events and does not increase the risk of recurrence of ICH.
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