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Correlation between anti-thrombotic drugs and hematoma expansion in acute intracerebral hemorrhage under strict blood pressure-lowering management: SAMURAI-ICH substudy Hisanao Akiyama St. Marianna University School of Medicine, Kanagawa, Japan Background: Few reports have documented the effect of pretreatment of anti-thrombotic agents on hematoma expansion in patients with intracerebral hemorrhage (ICH) under strict blood pressurelowering management in the acute phase. Methods: Patients (n=211) with hematoma in the supratentorial region were enrolled. Continuous intravenous administration of the anti-hypertensive drug nicardipine was commenced within 3 h of ICH onset at 10 hospitals in Japan, and systolic blood pressure was controlled between 120 and 160 mmHg. The correlation between pretreatment of anti-thrombotic agents and hematoma expansion (growth volume and rate 24 h after admission) was analyzed. Results: Subjects (n=211; 81 females, mean age, 65.6±12.0 years) had a median NIHSS score on admission of 13. Twenty-four patients were taking anti-thrombotic agents on admission, 14 aspirin alone, 1 aspirin+dipyridamole, 2 aspirin+cilostazol, 1 aspirin+clopidogrel, 2 ticlopidine alone, 2 cilostazol alone, and 2 warfarin. When divided into 3 groups according to hematoma volume on admission (≤3.0 ml, 3.1-11.9 ml, >11.9 ml), a significant difference (p=0.008) was observed between patients with and without pretreatment of anti-thrombotic agents (mean growth volume 24 h after admission: not taking anti-thrombotic agents, 4.73 ml: taking anti-thrombotic agents, 12.15 ml) only in the 3rd tertile group (volume>11.9 ml). By three months after discharge, four deaths unrelated to anti-thrombotic agents had occurred. Conclusions: Pretreatment of anti-thrombotic agents is likely significantly related to hematoma expansion in ICH patients with higher hematoma volume (>11.9 ml) on admission under strict blood pressure management in the acute phase.

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Correlation between anti-thrombotic drugs and hematoma expansion in acute intracerebral hemorrhage under strict blood pressure-lowering management: SAMURAI-ICH substudy