Prevalence and Clinical Characteristics of Intracerebral Hemorrhages Associated with Clopidogrel

Abstract

Background: As clopidogrel is being increasingly used, intracerebral hemorrhage (ICH) associated with clopidogrel are expected to
increase. We assessed the prevalence and clinical characteristics of of ICH with clopidogrel in a consecutive series of patients in two
hospitals.
Methods: We retrospectively reviewed the medication history of 204 patients (112 in one hospital and 92 in another – both individually
consecutive) admitted with ICH. We identified the patients who were using clopidogrel prior to ICH occurrence. The etiology of the
ICH was categorized on the basis of clinical history and diagnostic imaging, and outcome was subsequently evaluated.
Results: A total of 8 (4%) of the 204 patients were using clopidogrel prior to onset of ICH. Clopidogrel was the only medication in 3
patients and was used with aspirin or warfarin in 3 and 2 patients, respectively. Aspirin or warfarin was the only medication in 23
(%) and 14 (%) patients associated with ICH, respectively. The hematoma was located in the basal ganglia (n=2), lobes (n=2), thalamus (n=1), intraventricular (n=2), and cerebellar (n=2). One patient had secondary intraventricular extension. All patients using a
combination of clopidogrel and warfarin prior to ICH died.
Conclusion: The prevalence of ICH associated with clopidogrel is approximating the prevalence of aspirin- or warfarin-associated ICH.
The mortality with clopidogrel related ICH appears to be high particularly when in combination with another antithrombotic agent.