Table 4.
Association Between Use of Oral Antithrombotic Drugs and the Risk of Intracerebral Hemorrhage by Location—Direct Comparison of Cases, Lobar vs Nonlobar (Reference Group)
| Use of antithrombotic drugs | Main study | |||
| Lobar, no. (%) (n = 1,040) | Nonlobar, no. (%) (n = 1,263) | ORa (95% CI) | Adjusted ORb (95% CI) | |
| Nonuse of any antithromboticc | 468 (45.0) | 612 (48.5) | 1 (reference) | 1 (reference) |
| Current used,e | ||||
| Platelet antiaggregantsf | 317 (30.5) | 330 (26.1) | 1.17 (0.95–1.43) | 1.31 (1.02–1.69) |
| Low-dose aspirinf | 238 (22.9) | 262 (20.7) | 1.11 (0.89–1.39) | 1.21 (0.92–1.59) |
| Clopidogrelf | 79 (7.6) | 68 (5.4) | 1.41 (0.98–2.02) | 1.67 (1.05–2.65) |
| Oral anticoagulants | 185 (17.8) | 260 (20.6) | 0.89 (0.70–1.13) | 0.82 (0.60–1.13) |
| Vitamin K antagonist | 149 (14.3) | 195 (15.4) | 0.95 (0.74–1.24) | 0.82 (0.58–1.16) |
| Direct oral anticoagulants | 36 (3.5) | 65 (5.1) | 0.64 (0.41–1.01) | 0.75 (0.42–1.36) |
| Use of antithrombotic drugs | Brain CT substudyg | |||
| Lobar, no. (%) (n = 467) | Nonlobar, no. (%) (n = 572) | ORa (95% CI) | Adjusted ORb (95% CI) | |
| Nonuse of any antithromboticc | 186 (39.8) | 236 (41.3) | 1 (reference) | 1 (reference) |
| Current used,e | ||||
| Platelet antiaggregantsf | 142 (30.4) | 142 (24.8) | 1.06 (0.77–1.45) | 1.07 (0.73–1.59) |
| Low-dose aspirinf | 83 (17.8) | 91 (15.9) | 0.94 (0.65–1.37) | 0.99 (0.63–1.56) |
| Clopidogrelf | 59 (12.6) | 51 (8.9) | 1.18 (0.76–1.83) | 1.22 (0.68–2.19) |
| Oral anticoagulants | 99 (21.2) | 164 (28.7) | 0.60 (0.43–0.85) | 0.71 (0.46–1.10) |
| Vitamin K antagonist | 63 (13.5) | 95 (16.6) | 0.69 (0.46–1.03) | 0.72 (0.43–1.22) |
| Direct oral anticoagulants | 36 (7.7) | 69 (12.1) | 0.47 (0.29–0.77) | 0.48 (0.25–0.91) |
Abbreviations: CT = computerized tomography; OR = odds ratio.
Adjusted for age, sex, and calendar period.
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 oral anticoagulants, individual variables for use of aspirin, and clopidogrel, were adjusted for. In analyses of direct oral anticoagulants, individual variables for use of vitamin K antagonist were adjusted for, and vice versa. In analyses of aspirin, individual variables for use of clopidogrel were adjusted for, and vice versa. Analyses of platelet antiaggregants, aspirin, and clopidogrel did not include patients with use of oral anticoagulants within the past 12 mo before index date, see footnote e below.
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 oral anticoagulant and one or more platelet antiaggregants were classified exclusively as oral anticoagulant users (and as vitamin K antagonist/direct oral anticoagulant users in analyses of these drug-classes).
Single-platelet antiaggregant use only, that is, concurrent dual platelet antiaggregant use not included.
Includes patients aged 55 years or older at onset of ICH admitted to hospital in 2015–2018 with first-ever spontaneous intracerebral hemorrhage. Index brain CTs of these patients were re-evaluated masked to clinical data with hematoma location classified according to the Cerebral Haemorrhage Anatomical RaTing Instrument (CHARTS).