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DOI: 10.1160/TH11-06-0439
Use of aspirin in Chinese after recovery from primary intracranial haemorrhage
Publication History
Received:
29 June 2011
Accepted after major revision:
04 November 2011
Publication Date:
29 November 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/201202/lookinside/thumbnails/10-1160-th11-06-0439-1.jpg)
Summary
Intracranial haemorrhage (ICH) accounts for ~35% of all strokes in Chinese. Anti-platelet agent is often avoided after an index event due to the possibility of recurrent ICH. This single-centered observational study included 440 consecutive Chinese patients with a first spontaneous ICH surviving the first month performed during 1996–2010. The subjects were identified, and their clinical characteristics, anti-platelet therapy after ICH, and outcomes including recurrent ICH, ischaemic stroke, and acute coronary syndrome were checked from hospital records. Of these 440 patients, 56 patients (12.7%) were prescribed aspirin (312 patient-aspirin years). After a follow-up of 62.2 ± 1.8 months, 47 patients had recurrent ICH (10.7%, 20.6 per 1,000 patient years). Patients prescribed aspirin did not have a higher risk of recurrent ICH compared with those not prescribed aspirin (22.7 per 1,000 patient-aspirin years vs. 22.4 per 1,000 patient years, p=0.70). Multivariate analysis identified age > 60 years (hazard ratio [HR]: 2.0, 95% confidence interval [CI]: 1.07–3.85, p=0.03) and hypertension (HR: 2.0, 95% CI: 1.06–3.75, p=0.03) as independent predictors for recurrent ICH. In a subgroup analysis including 127 patients with standard indications for aspirin of whom 56 were prescribed aspirin, the incidence of combined vascular events including recurrent ICH, ischaemic stroke, and acute coronary syndrome was statistically lower in patients prescribed aspirin than those not prescribed aspirin (52.4 per 1,000 patient-aspirin years, vs. 112.8 per 1,000 patient-years, p=0.04). In conclusion, we observed in a cohort of Chinese post-ICH patients that aspirin use was not associated with an increased risk for a recurrent ICH.
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References
- 1 Feigin VL, Lawes CM, Bennett DA. et al. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century.. Lancet Neurol 2003; 2: 43-53.
- 2 Kolominsky-Rabas PL, Sarti C, Heuschmann PU. et al. A prospective community-based study of stroke in Germany--the Erlangen Stroke Project (ESPro): incidence and case fatality at 1, 3, and 12 months. Stroke 1998; 29: 2501-2506.
- 3 Thrift AG, Dewey HM, Macdonell RA. et al. Incidence of the major stroke subtypes: initial findings from the North East Melbourne stroke incidence study (NEMESIS).. Stroke 2001; 32: 1732-1738.
- 4 Yang QD, Niu Q, Zhou YH. et al. Incidence of cerebral hemorrhage in the Changsha community. A prospective study from 1986 to 2000. Cerebrovasc Dis 2004; 17: 303-313.
- 5 Zhang LF, Yang J, Hong Z. et al. Proportion of different subtypes of stroke in China.. Stroke 2003; 34: 2091-2096.
- 6 Huang CY, Chan FL, Yu YL. et al. Cerebrovascular disease in Hong Kong Chinese. Stroke 1990; 21: 230-235.
- 7 Broderick J, Connolly S, Feldmann E. et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group.. Stroke 2007; 38: 2001-2023.
- 8 Vermeer SE, Algra A, Franke CL. et al. Long-term prognosis after recovery from primary intracerebral hemorrhage.. Neurology 2002; 59: 205-209.
- 9 Wani M, Nga E, Navaratnasingham R.. Should a patient with primary intracerebral haemorrhage receive antiplatelet or anticoagulant therapy?. Br Med J 2005; 331: 439-442.
- 10 Flynn RW, MacDonald TM, Murray GD. et al. Prescribing antiplatelet medicine and subsequent events after intracerebral hemorrhage.. Stroke 2010; 41: 2606-2611.
- 11 Viswanathan A, Rakich SM, Engel C. et al. Antiplatelet use after intracerebral hemorrhage.. Neurology 2006; 66: 206-209.
- 12 Ho LY, Siu CW, Yue WS. et al. Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension.. J Hum Hypertens 2011; 25: 304-310.
- 13 Siu CW, Jim MH, Ho HH. et al. Transient atrial fibrillation complicating acute inferior myocardial infarction: implications for future risk of ischemic stroke.. Chest 2007; 132: 44-49.
- 14 Siu CW, Jim MH, Lau CP. et al. Low molecular weight heparin versus unfractionated heparin for thromboprophylaxis in patients with acute atrial fibrillation: A randomized control trial.. Acute Card Care 2011; 13: 196-198.
- 15 Siu CW, Pong V, Jim MH. et al. Beta-blocker in post-myocardial infarct survivors with preserved left ventricular systolic function.. Pacing Clin Electrophysiol 2010; 33: 675-680.
- 16 Ho HH, Kwok OH, Jim MH. et al. Long-term clinical outcomes after intravascular brachytherapy for instent restenosis and de novo coronary artery lesions in percutaneous coronary intervention.. Cardiovasc Revasc Med 2011; 12: 152-157.
- 17 Ho HH, Pong V, Siu CW. et al. Long-term clinical outcomes of drug-eluting stents vs bare-metal stents in Chinese patients. Clin Cardiol 2010; 33: E22-29.
- 18 Passero S, Burgalassi L, D'Andrea P. et al. Recurrence of bleeding in patients with primary intracerebral hemorrhage. Stroke 1995; 26: 1189-1192.
- 19 Hart RG, Tonarelli SB, Pearce LA.. Avoiding central nervous system bleeding during antithrombotic therapy: recent data and ideas. Stroke 2005; 36: 1588-1593.
- 20 Xu T, Wang Y, Li W. et al. Survey of prevalence, awareness, treatment, and control of hypertension among Chinese governmental and institutional employees in Beijing. Clin Cardiol 2010; 33: E66-72.
- 21 Nakamura K, Barzi F, Lam TH. et al. Cigarette smoking, systolic blood pressure, and cardiovascular diseases in the Asia-Pacific region.. Stroke 2008; 39: 1694-1702.
- 22 Zhang XF, Attia J, D'Este C. et al. The relationship between higher blood pressure and ischaemic, haemorrhagic stroke among Chinese and Caucasians: meta-analysis.. Eur J Cardiovasc Prev Rehabil 2006; 13: 429-437.
- 23 Arima H, Tzourio C, Anderson C. et al. Effects of perindopril-based lowering of blood pressure on intracerebral hemorrhage related to amyloid angiopathy: the PROGRESS trial.. Stroke 2010; 41: 394-396.
- 24 Bae H, Jeong D, Doh J. et al. Recurrence of bleeding in patients with hypertensive intracerebral hemorrhage. Cerebrovasc Dis 1999; 9: 102-108.
- 25 Morgenstern LB, Hemphill 3rd JC, Anderson C. et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.. Stroke 2010; 41: 2108-2129.
- 26 Steiner T, Kaste M, Forsting M. et al. Recommendations for the management of intracranial haemorrhage – part I: spontaneous intracerebral haemorrhage. The European Stroke Initiative Writing Committee and the Writing Committee for the EUSI Executive Committee. Cerebrovasc Dis 2006; 22: 294-316.
- 27 Lovelock CE, Cordonnier C, Naka H. et al. Antithrombotic drug use, cerebral microbleeds, and intracerebral hemorrhage: a systematic review of published and unpublished studies.. Stroke 2010; 41: 1222-1228.
- 28 Pang GF, Cao YZ, Fan CL. et al. Determination of clopidol residues in chicken tissues by liquid chromatography: collaborative study.. J AOAC Int 2003; 86: 685-693.
- 29 Biffi A, Halpin A, Towfighi A. et al. Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy.. Neurology 2010; 75: 693-698.