Abstract A146: Antiplatelet Therapy Combinations and Outcomes after Spontaneous Intracerebral Hemorrhage in the AHA Get With The Guidelines Registry

Introduction: Prior studies evaluating the relationship between antiplatelet therapy (APT) and outcomes after spontaneous intracerebral hemorrhage (ICH) have grouped all antiplatelet agents together, and it is therefore unclear if specific antiplatelet agents or particular combinations of antiplatelet medications have differential effects on ICH outcomes. Methods: We performed a retrospective cohort study of patients with ICH from 2011-2021 in the Get With The Guidelines-Stroke registry. The exposure was the type of APT defined as either monothrerapy (aspirin, clopidogrel, prasugrel, ticagrelor used alone), dual APT combinations involving these 4 medications, or no APT. The outcomes were in-hospital mortality, and unfavorable discharge disposition defined as a composite of in-hospital mortality or hospice discharge. We used multiple logistic regression to study the relationship between incremental APT combinations and outcomes, after adjustment for demographics, vascular comorbidities, ICH severity (NIHSS Stroke Scale, external ventricular drain use), hospital characteristics (teaching status, urban location, annual case volume), and withdrawal of care. Results: Among 426,481 patients with ICH, 109,512 were on APT monotherapy, 17,009 were on dual APT, while 300,558 did not receive any APT prior to the ICH. In the multivariate logistic regression analyses, aspirin monotherapy was not associated with higher mortality compared with no APT, but clopidogrel, prasugrel, and ticagrelor monotherapies, and all dual APT combinations, were associated with higher odds of in-hospital mortality (Figure 1). Aspirin monotherapy was associated with lower odds of unfavorable discharge disposition compared with no APT, but there was a trend suggesting higher odds of unfavorable discharge disposition with other APT monotherapies and dual APT combinations (Figure 2). Conclusions: In a large, diverse US cohort of ICH patients, increasing potency of antiplatelet therapy at the time of ICH was associated with higher mortality and a trend toward poor discharge disposition. Better knowledge of these relationships will be crucial in the management of antiplatelet associated ICH.