Abstract Number: Esoc2026lb59 Pre-ich Anti-platelet Medication Selects Patients at High Risk for Hematoma Expansion That Is Decreased by Recombinant Factor Viia
Year: 2026
Type: conference-abstract
Abstract: Background and aims Hematoma expansion (HE) is a preventable cause of poor outcome in patients with acute intracerebral hemorrhage (ICH). Predicting which patients will have HE is crucial to target hemostatic treatment. Patients who take pre-ICH anti-platelet medication may be at higher risk for HE, however, it is unclear if hemostatic treatment would be more effective in these patients. Methods We identified patients who took pre-ICH anti-platelet medications at enrollment into FASTEST, a prospective, randomized trial of recombinant Factor VII (rFVIIa) within two hours of symptom onset. HE was measured centrally from serial CT scans. These data are from a pre-planned interim analysis. Results We enrolled 626 patients. Anti-platelet medications prior to enrollment were none (N=541, 86%), aspirin only (N=66, 11%), P2Y12 inhibitors (e.g., clopidogrel, N=16, 3%), and both aspirin and P2Y12 inhibitors (N=3, <1%). Baseline severity of ICH and time to imaging were similar between groups. Randomization to rFVIIa was predictive of less HE overall, especially in patients with pre-ICH aspirin use. In patients with no pre-ICH antiplatelet use, rFVIIa reduced hematoma expansion from 4.7 +/- 12.8 mL to 1.5 +/- 5.6 mL (P=0.002), a difference of 3.2 mL (P=0.0002). In patients with pre-ICH aspirin use, rFVIIa decreased HE from 12.3 +/- 19.3 mL to 1.4 +/- 2.8 mL, a difference of 10.9 mL (P=0.004). Conclusions Pre-ICH aspirin and short time from symptom onset identifies patients at high risk for HE, a targetable population for haemostatic treatment. Patients who took pre-ICH aspirin had substantial HE that was attenuated by rFVIIa. Conflict of interest Table 1 - belongs to Results
Source: European Stroke Journal
Institutions: Northwestern University, University of Cincinnati, Memorial Hermann, Texas Medical Center, Memorial Hermann–Texas Medical Center, Medical University of South Carolina, National Cerebral and Cardiovascular Center, University of Ottawa, Ottawa Hospital Research Institute, University of Calgary, University of Nottingham, Queen's Medical Centre, Klinikum Frankfurt Höchst, Yale University
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,400
OpenAlex ID: W7160418351
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