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Abstract

Introduction:

Patients with intracranial hemorrhage (including intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic hemorrhage) are commonly admitted to the intensive care unit (ICU). Although indications for oral antiplatelet agents are increasing, the impact of preadmission use on outcomes in patients with intracranial hemorrhage admitted to the ICU is unknown. We sought to evaluate the association between preadmission oral antiplatelet use, in-hospital mortality, resource utilization, and costs among ICU patients with intracranial hemorrhage.

Methods:

We retrospectively analyzed a prospectively collected registry (2011-2016) and included consecutive adult patients from 2 hospitals admitted to ICU with intracranial hemorrhage. Patients were categorized on the basis of preadmission oral antiplatelet use. We excluded patients with preadmission anticoagulant use. The primary outcome was in-hospital mortality and was analyzed using a multivariable logistic regression model. Contributors to total hospital cost were analyzed using a generalized linear model with log link and gamma distribution.

Results:

Of 720 included patients with intracranial hemorrhage, 107 (14.9%) had been using an oral antiplatelet agent at the time of ICU admission. Oral antiplatelet use was not associated with in-hospital mortality (adjusted odds ratio: 1.31 [95% confidence interval [CI]: 0.93-2.22]). Evaluation of total costs also revealed no association with oral antiplatelet use (adjusted ratio of means [aROM]: 0.92 [95% CI: 0.82-1.02, P = .10]). Total cost among patients with intracranial hemorrhage was driven by illness severity (aROM: 1.96 [95% CI: 1.94-1.98], P < .001), increasing ICU length of stay (aROM: 1.05 [95% CI: 1.05-1.06], P < .001), and use of invasive mechanical ventilation (aROM: 1.76 [95% CI: 1.68-1.86], P < .001).

Conclusions:

Among ICU patients admitted with intracranial hemorrhage, preadmission oral antiplatelet use was not associated with increased in-hospital mortality or hospital costs. These findings have important prognostic implications for clinicians who care for patients with intracranial hemorrhage.

Keywords

intracranial hemorrhage antiplatelet intensive care unit subarachnoid hemorrhage intracerebral hemorrhage traumatic brain injury health economics

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References

Fernando

Tran

Cheng

, et al. Diagnosis of elevated intracranial pressure in critically ill adults: systematic review and meta-analysis. BMJ. 2019;366:l4225.

Cordonnier

Demchuk

Ziai

Anderson

. Intracerebral haemorrhage: current approaches to acute management. Lancet. 2018;392(10154):1257–1268.

Lawton

Vates

. Subarachnoid hemorrhage. N Engl J Med. 2017;377(3):257–266.

Majdan

Plancikova

Brazinova

, et al. Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. Lancet Public Health. 2016;1(2): e76–e83.

Oppenheim-Eden

Glantz

Eidelman

Sprung

. Spontaneous intracerebral hemorrhage in critically ill patients: incidence over six years and associated factors. Intensive Care Med. 1999;25(1):63–67.

Udy

Vladic

Saxby

, et al. Subarachnoid hemorrhage patients admitted to intensive care in australia and new zealand: a multicenter cohort analysis of in-hospital mortality over 15 years. Crit Care Med. 2017;45(2): e138–e45.

Fernando

Reardon

Dowlatshahi

, et al. Outcomes and costs of patients admitted to the ICU due to spontaneous intracranial hemorrhage. Crit Care Med. 2018;46(5): e395–e403.

Doble

Pufulete

Harris

, et al. Health-related quality of life impact of minor and major bleeding events during dual antiplatelet therapy: a systematic literature review and patient preference elicitation study. Health Qual Life Outcom. 2018;16(1):191.

Geraghty

Mehta

Rothwell

. Age-specific risks, severity, time course, and outcome of bleeding on long-term antiplatelet treatment after vascular events: a population-based cohort study. Lancet. 2017;390(10093):490–499.

10.

Fabbri

Servadei

Marchesini

Bronzoni

Montesi

Arietta

. Antiplatelet therapy and the outcome of subjects with intracranial injury: the Italian SIMEU study. Crit Care. 2013;17(2):R53.

11.

Can

Rudy

Castro

, et al. Association between aspirin dose and subarachnoid hemorrhage from saccular aneurysms: a case-control study. Neurol. 2018;91(12): e1175–e81.

12.

Peck

Calvo

Schechter

, et al. The impact of preinjury anticoagulants and prescription antiplatelet agents on outcomes in older patients with traumatic brain injury. J Trauma Acute Care Surg. 2014;76(2):431–436.

13.

Stuntz

Bernstein

. Recent trends in the prevalence of low-dose aspirin use for primary and secondary prevention of cardiovascular disease in the United States, 2012-2015. Prev Med Rep. 2017;5:183–186. doi:10.1016/j.pmedr.2016.12.023.

14.

Fernando

Reardon

Rochwerg

, et al. Sepsis-3 septic shock criteria and associated mortality among infected hospitalized patients assessed by a rapid response team. Chest. 2018;154(2):309–316.

15.

Fernando

Rochwerg

Reardon

, et al. Emergency department disposition decisions and associated mortality and costs in ICU patients with suspected infection. Crit Care. 2018;22(1):172.

16.

Elixhauser

Steiner

Harris

Coffey

. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8–27.

17.

Marshall

Cook

Christou

Bernard

Sprung

Sibbald

. Multiple Organ Dysfunction Score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23(10):1638–1652.

18.

Fernando

Reardon

Ball

, et al. Outcomes and costs of patients admitted to the intensive care unit due to accidental or intentional poisoning. J Intensive Care Med. 2018:885066617754046. doi:10.1177/0885066617754046.

19.

Ronksley

McKay

Kobewka

Mulpuru

Forster

. Patterns of health care use in a high-cost inpatient population in Ottawa, Ontario: a retrospective observational study. CMAJ Open. 2015;3(1): E111–E118.

20.

Lederer

Bell

Branson

, et al. Control of confounding and reporting of results in causal inference studies. Guidance for authors from editors of Respiratory, Sleep, and Critical Care journals. Ann Am Thorac Soc. 2019;16(1):22–28.

21.

Blough

Ramsey

. Using generalized linear models to assess medical care costs. Health Serv Outcomes Res Methodol. 2000;1(2):185–202.

22.

Gregori

Petrinco

Desideri

Merletti

Pagano

. Regression models for analyzing costs and their determinants in health care: an introductory review. Int J Qual Health Care. 2011;23(3):331–341.

23.

Wilson

Seiffge

Traenka

, et al. Outcome of intracerebral hemorrhage associated with different oral anticoagulants. Neurology. 2017;88(18):1693–1700.

24.

Dowlatshahi

Butcher

Asdaghi

, et al. Poor prognosis in warfarin-associated intracranial hemorrhage despite anticoagulation reversal. Stroke. 2012;43(7):1812–1817.

25.

Al-Shahi Salman

Frantzias

Lee

, et al. Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data. Lancet Neurol. 2018;17(10):885–894.

26.

Toussaint

III Friedman

Wijdicks

, et al. Influence of aspirin on outcome following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2004;101(6):921–925.

27.

Dorhout Mees

Rinkel

Hop

Algra

van Gijn

. Antiplatelet therapy in aneurysmal subarachnoid hemorrhage: a systematic review. Stroke. 2003;34(9):2285–2289.

28.

Dorhout Mees

van den Bergh

Algra

Rinkel

. Antiplatelet therapy for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2007;17(4): Cd006184.

29.

McMillian

Rogers

. Management of prehospital antiplatelet and anticoagulant therapy in traumatic head injury: a review. J Trauma. 2009;66(3):942–950.

30.

Rozzelle

Wofford

Branch

. Predictors of hospital mortality in older patients with subdural hematoma. J Am Geriatr Soc. 1995;43(3):240–244.

31.

Kramer

Dasta

Kane-Gill

. The impact of mortality on total costs within the ICU. Crit Care Med. 2017;45(9):1457–1463.

32.

Kyeremanteng

Wan

D’Egidio

Neilipovitz

. Approach to economic analysis in critical care. J Crit Care. 2016;36:92–96.

33.

Dasta

McLaughlin

Mody

Piech

. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005;33(6):1266–1271.

34.

Pereira

Sanchez-Pena

Biondi

, et al. Predictors of 1-year outcome after coiling for poor-grade subarachnoid aneurysmal hemorrhage. Neurocrit Care. 2007;7(1):18–26.

35.

Rinkel

Klijn

. Prevention and treatment of medical and neurological complications in patients with aneurysmal subarachnoid haemorrhage. Pract Neurol. 2009;9(4):195–209.

36.

English

McIntyre

Fergusson

, et al. Subarachnoid hemorrhage admissions retrospectively identified using a prediction model. Neurology. 2016;87(15):1557–1564.

37.

English

McIntyre

Fergusson

, et al. Enriched administrative data can be used to retrospectively identify all known cases of primary subarachnoid hemorrhage. J Clin Epidemiol . 2016;70:146–154.

38.

Baharoglu

Cordonnier

Al-Shahi Salman

, et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet. 2016;387(10038):2605–2613.

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Preadmission Antiplatelet Use and Associated Outcomes and Costs Among ICU Patients With Intracranial Hemorrhage

Abstract

Introduction:

Methods:

Results:

Conclusions:

Keywords

Get full access to this article

References

Supplementary Material