Hormuzdiyar H. Dasenbrock|Sandra C. Yan|Bradley A. Gross|Donovan Guttieres|William B. Gormley|Kai U. Frerichs|Mohammad Ali Aziz?Sultan|Rose Du
The impact of aspirin and anticoagulant usage on outcomes after aneurysmal subarachnoid hemorrhage: a Nationwide Inpatient Sample analysis
Neurological Surgery|Brigham and Women's Hospital|Harvard University|Brown University|Brigham and Women's Hospital|Neurological Surgery|Providence College|Barrow Neurological Institute|Neurological Surgery|Brigham and Women's Hospital|Neurological Surgery|Brigham and Women's Hospital|Neurological Surgery|Harvard University|University of Mary|Brigham and Women's Hospital|Neurological Surgery|Harvard University|University of Mary|Brigham and Women's Hospital|Harvard University|Neurological Surgery|Harvard University|Brigham and Women's Hospital|Neurological Surgery
objective although aspirin usage may associated decreased risk rupture cerebral aneurysms potential therapeutic benefit aspirin must weighed theoretical risk greater hemorrhage volume subarachnoid hemorrhage sah occurs however studies evaluated association prehemorrhage aspirin use outcomes first nationwide analysis evaluate impact longterm aspirin anticoagulant use outcomes sah methods data nationwide inpatient sample nis 20062011 extracted patients primary diagnosis sah underwent microsurgical endovascular aneurysm repair included diagnosis arteriovenous malformation excluded multivariable logistic regression performed calculate adjusted odds inhospital mortality nonroutine discharge discharge home poor outcome death discharge institutional care tracheostomy gastrostomy patients longterm aspirin anticoagulant use multivariable linear regression used evaluate length hospital stay covariates included patient age sex comorbidities primary payer nissah severity scale intracerebral hemorrhage cerebral edema herniation modality aneurysm repair hospital bed size whether hospital teaching hospital subgroup analyses exclusively evaluated patients treated surgically endovascularly results study examined 11549 hospital admissions aspirin 21 n 245 anticoagulant users 09 n 108 significantly older greater burden comorbid disease p 0001 severity sah slightly lower longterm aspirin use p 003 neither inhospital mortality 135 vs 126 total complication rates 796 vs 800 differed significantly longterm aspirin use additionally aspirin use associated decreased odds cardiac complication 057 95 ci 036091 p 002 venous thromboembolic events 053 95 ci 030094 p 003 length stay significantly shorter 15 days vs 17 days 1273 95 ci 5222024 p 0001 odds nonroutine discharge lower 063 95 ci 048083 p 0001 aspirin users subgroup analyses benefits aspirin primarily noted patients underwent coil embolization likewise among patients treated endovascularly adjusted odds poor outcome lower among longterm aspirin users 318 vs 374 063 95 ci 042094 p 003 although crude rates inhospital mortality 194 vs 126 poor outcome 536 vs 376 higher longterm anticoagulant users multivariable logistic regression models variations significantly different mortality 136 95 ci 089207 p 016 poor outcome 109 95 ci 069173 p 072 conclusions nationwide study neither longterm aspirin anticoagulant use associated differential mortality complication rates sah aspirin use associated shorter hospital stay lower rates nonroutine discharge benefits primarily observed patients treated endovascularly