Table 3.
Association Between Use of Oral Antithrombotic Drugs and the Risk of Cerebral Amyloid Angiopathy-Related Intracerebral Hemorrhage According to the Simplified Edinburgh Criteria
|
Use of antithrombotic drugs |
Lobar ICH | Lobar s-ICH—low/intermediate CAA probability (only FLP, only cSAH, or no FLP or cSAH) | Lobar s-ICH—high CAA probability (FLP and cSAH) | p Valueb | ||||||
| Cases, no. (%) (n = 467) | Controls, no. (%) (n = 18,679) | Adjusted ORa (95% CI) | Cases, no. (%) (n = 319) | Controls, no. (%) (n = 12,760) | Adjusted ORa (95% CI) | Cases, no. (%) (n = 148) | Controls, no. (%) (n = 5,919) | Adjusted ORa (95% CI) | ||
| No use of any antithromboticc | 186 (39.8) | 10,992 (58.8) | 1 (reference) | 134 (42.0) | 7,480 (58.6) | 1 (reference) | 52 (35.1) | 3,512 (59.3) | 1 (reference) | |
| Current used,e | ||||||||||
| Platelet antiaggregantsf | 142 (30.4) | 4,515 (24.2) | 2.43 (1.84–3.22) | 87 (27.3) | 3,086 (24.2) | 1.88 (1.33–2.65) | 55 (37.2) | 1,429 (24.1) | 3.90 (2.41–6.30) | 0.018 |
| Low-dose aspirinf | 83 (17.8) | 3,373 (18.1) | 2.04 (1.47–2.83) | 44 (13.8) | 2,308 (18.1) | 1.44 (0.94–2.20) | 39 (26.4) | 1,065 (18.0) | 3.61 (2.11–6.18) | 0.010 |
| Clopidogrelf | 59 (12.6) | 1,142 (6.1) | 3.74 (2.51–5.58) | 43 (13.5) | 778 (6.1) | 3.45 (2.14–5.57) | 16 (10.8) | 364 (6.1) | 4.27 (1.97–9.26) | 0.65 |
| Oral anticoagulants | 99 (21.2) | 2,290 (12.3) | 3.31 (2.38–4.61) | 73 (22.9) | 1,596 (12.5) | 3.41 (2.30–5.03) | 26 (17.6) | 694 (11.7) | 3.26 (1.74–6.09) | 0.90 |
| VKA | 63 (13.5) | 1,262 (6.8) | 4.17 (2.82–6.19) | 47 (14.7) | 894 (7.0) | 4.83 (3.05–7.66) | 16 (10.8) | 368 (6.2) | 3.17 (1.44–6.96) | 0.37 |
| DOAC | 36 (7.7) | 1,028 (5.5) | 1.95 (1.18–3.22) | 26 (8.2) | 702 (5.5) | 1.86 (1.02–3.38) | 10 (6.8) | 326 (5.5) | 2.18 (0.84–5.62) | 0.78 |
Abbreviations: CAA = cerebral amyloid angiopathy; DOAC = direct oral anticoagulant; OAC = oral anticoagulant; OR = odds ratio; s-ICH = spontaneous intracerebral hemorrhage; VKA = vitamin K antagonist.
Adjusted for age, sex, and calendar period and for the following, based on register data: hypertension, previous ischemic stroke, diabetes, chronic renal insufficiency, chronic hepatic disease, heart failure, ischemic heart disease, peripheral artery disease, cancer, dementia, disorders indicative of high alcohol consumption, chronic obstructive pulmonary disease (as a marker of smoking), and the use of antihypertensive drugs, statins, nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors, proton pump inhibitors, hormone replacement therapy (women only), and oral corticosteroid drugs. In analyses of OACs, individual variables for use of aspirin, and clopidogrel, were adjusted for. Analyses of platelet antiaggregants, aspirin, and clopidogrel did not include patients with use of OACs within the past 12 mo before index date, see footnote e below.
Wald test comparing same agent for high CAA probability vs low/intermediate CAA probability.
No use of any antithrombotic drug in the 12 mo before index date.
Based on the most recent treatment episode before the index date (date of diagnosis for cases and date of selection for controls), exposure categorized as current use if treatment episode ended 0–30 d before index date.
Current users of both an OAC and one or more platelet antiaggregants were classified exclusively as OAC users (and as VKA/DOAC users in analyses of these drug classes).
Single-platelet antiaggregant use only, that is, concurrent dual platelet antiaggregant use not included.