Reduced platelet activity is associated with more intraventricular hemorrhage

Neurosurgery. 2009 Oct;65(4):684-8; discussion 688. doi: 10.1227/01.NEU.0000351769.39990.16.


Objective: Intraventricular hemorrhage (IVH) is a serious complication of intracerebral hemorrhage (ICH). We hypothesized that antiplatelet medication use and platelet activity would be associated with more IVH.

Methods: We prospectively identified patients with spontaneous ICH and measured platelet activity on admission with the VerifyNow-Aspirin assay (Accumetrics, San Diego, CA). IVH volume was quantified with the Graeb scale, divided into categories of 0 (no IVH), 1 to 2 (minimal IVH), 3 to 5 (moderate IVH), and 6 and above (severe IVH). Antiplatelet medications were prospectively recorded. We used ordinal regression to measure the effect of platelet activity after correcting for ICH location and ICH volume. Outcomes were measured at 14 days or discharge with the National Institutes of Health Stroke Scale and modified Rankin Scale (mRS) and at 28 days and 3 months with the mRS.

Results: In our cohort of 73 patients, 36 had no IVH, 11 had minimal IVH, 10 had moderate IVH, and 16 had severe IVH. Aspirin and clopidogrel (P = 0.03 for both) were associated with less platelet activity. More IVH was related to reduced platelet activity (P = 0.01) after correction for ICH volume and location without contribution from aspirin or clopidogrel use. IVH was associated with worse National Institutes of Health Stroke Scale score (P = 0.002) and mRS score (P = 0.001) at 14 days and with mRS scores at 28 days (P = 0.02) and 3 months (P = 0.008).

Conclusion: Reduced platelet activity was related to more IVH as a complication of ICH. The relationship of platelet activity to IVH deserves further study.

MeSH terms

  • Adult
  • Aged
  • Aspirin / adverse effects
  • Blood Platelet Disorders / chemically induced
  • Blood Platelet Disorders / epidemiology*
  • Blood Platelet Disorders / physiopathology*
  • Blood Platelets / physiology*
  • Cerebral Hemorrhage / epidemiology*
  • Cerebral Hemorrhage / physiopathology*
  • Clopidogrel
  • Cohort Studies
  • Comorbidity
  • Disease Progression
  • Female
  • Humans
  • Lateral Ventricles / blood supply
  • Lateral Ventricles / physiopathology*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Platelet Aggregation Inhibitors / adverse effects
  • Prospective Studies
  • Ticlopidine / adverse effects
  • Ticlopidine / analogs & derivatives


  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Ticlopidine
  • Aspirin