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Abstract
Objective: To investigate the relationship between hemorrhagic stroke and use of antiplatelets and warfarin using data from The Health Improvement Network.
Methods: A total of 1,797 incident cases of intracerebral hemorrhage (ICH) and 1,340 of subarachnoid hemorrhage (SAH) were ascertained. Density-based sampling was used to select 10,000 controls free from hemorrhagic stroke. Risk of hemorrhagic stroke was evaluated in current users and nonusers of antiplatelets and warfarin. Unconditional logistic regression models were used to adjust for age, sex, calendar year, alcohol, body mass index, hypertension, and health services utilization.
Results: Aspirin use was not associated with an increased risk of ICH (odds ratio [OR] 1.06, 95% confidence interval [CI] 0.93–1.21), but was associated with a decreased risk of SAH (OR 0.82, 95% CI 0.67–1.00), compared with no therapy. Aspirin use ≥3 years was associated with a decreased risk of SAH (OR 0.63, 95% CI 0.45–0.90) compared with no therapy. Warfarin use was associated with a greatly increased risk of ICH (OR 2.82, 95% CI 2.26–3.53) and a moderately increased risk of SAH (OR 1.67, 95% CI 1.15–2.43) compared with no therapy. International normalized ratio values ≥3 carried a marked risk of ICH (OR 7.01, 95% CI 4.10–11.99).
Conclusion: Aspirin is not associated with a risk of ICH compared with no therapy. Chronic low-dose aspirin treatment may have a protective effect on the risk of SAH. Warfarin users in this study cohort were at a much higher risk of ICH than those receiving no therapy, with a marked association with international normalized ratio >3.
GLOSSARY
- CI=
- confidence interval;
- ICH=
- intracerebral hemorrhage;
- INR=
- international normalized ratio;
- OR=
- odds ratio;
- PCP=
- primary care physician;
- SAH=
- subarachnoid hemorrhage;
- THIN=
- The Health Improvement Network
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
See page 559
Supplemental data at www.neurology.org
- Received January 23, 2013.
- Accepted in final form May 7, 2013.
- © 2013 American Academy of Neurology
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