Abstract Details

Title An Association of Antiplatelet Use and Outcomes In Aneurysmal Subarachnoid Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S35 - Cerebrovascular Disease: Meta-analyses and Outcomes Research (2:24 PM-2:36 PM)

Poster/Presentation
Number 008

Background Antiplatelet agents are commonly used after endovascular repair of ruptured aneurysms in patients with subarachnoid hemorrhage (SAH). Recent evidence suggests post-treatment antiplatelets may reduce risk of delayed cerebral ischemia (DCI) and worsen outcomes.

Objective We sought to determine potential risks and benefits of antiplatelets in our patients’ population.

Design/Methods This is a retrospective cohort study of consecutive patients with aneurysmal SAH who were admitted to an academic referral center from 2016 to 2021. We used multivariable logistic regression analysis, propensity score matching and multiple linear regression to test the association of antiplatelets use and functional outcome (modified Rankin Scale at 3 months), DCI, any intracranial hemorrhagic complications including EVD tract hemorrhage and ICU length of stay (continuous variable).

Results Of the confirmed aneurysmal SAH patients (n=315), mean age was 57 years (SD 13.6) and majority of patients were female (62%) and white (70%). Thirty-nine percent of patients received antiplatelets (26% single agent; 13% dual agents) with no differences in demographics. Of the patients in the cohort, 85% received endovascular treatments (including 59% coil, 12% pipeline and stent assisted coil, 14 other endovascular treatments) and 15% underwent surgical clipping. Antiplatelets were used more in aneurysms originating from posterior circulation compared to anterior circulation (54% vs 35%, p=0.012). There was no difference in functional outcome (modified Rankin Scale at 3 months), DCI, or any intracranial hemorrhagic complications including EVD tract hemorrhage. ICU length of stay was longer in patients who received antiplatelets (3.32 additional days, 95% CI 0.4-6.3; p=0.02) and this association was independent of Hunt and Hess grades, modified Fisher scales, aneurysm treatment modality, age, comorbidities, and hospital complications.

Conclusions Use of antiplatelets may not reduce risk of DCI and worse outcome but can be associated with longer ICU length of stay. Further studies are required to identify appropriate candidates who may benefit from antiplatelets.

Authors/Disclosures
Bianca H. Persaud PRESENTER	Ms. Persaud has nothing to disclose.
Kareem Joudi	Mr. Joudi has nothing to disclose.
Christoph Stretz, MD, FAAN (Rhode Island Hospital, Department of Neurology)	Dr. Stretz has nothing to disclose.
Nicholas S. Potter, MD, PhD (Rhode Island Hospital)	Dr. Potter has nothing to disclose.
Shawna M. Cutting, MD, FAAN	The institution of Dr. Cutting has received research support from Genentech.
Linda C. Wendell, MD, FAAN (Mount Auburn Hospital)	Dr. Wendell has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. An immediate family member of Dr. Wendell has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. Dr. Wendell has stock in Apple. An immediate family member of Dr. Wendell has stock in Apple.
Bradford B. Thompson, MD (St. Elizabeth’s Medical Center)	Dr. Thompson has nothing to disclose.
Karen L. Furie, MD (RIH/Alpert Medical School of Brown Univ)	The institution of Dr. Furie has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen/BMS. Dr. Furie has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for BMJ/JNNP. The institution of Dr. Furie has received research support from NINDS.
Jesse Menville	Ms. Menville has nothing to disclose.
Ali Mahta, MD (Brown University)	Dr. Mahta has nothing to disclose.