Imaging Characteristics And Dynamic Analysis Of Antithrombotic Drug-related Cerebral Hemorrhage

Objective To study the imaging characteristics and dynamic changes of hematoma volume of anti-thrombotic drug-related cerebral hemorrhage（ATT-ICH）,and to clarify the differences of hematoma morphology,hematoma absorption and hematoma growth between anti-thrombotic drug-related cerebral hemorrhage（ATT-ICH）and non-antithrombotic drug-related cerebral hemorrhage（Non-ATT-ICH）.Methods A total of 236 patients with cerebral hemorrhage from May 2018 to January2019 in the Department of Neurology,Baotou Central Hospital of Inner Mongolia were collected continuously.Cerebral hemorrhage caused by trauma,brain tumors,cerebral vascular malformations,intracranial aneurysms,aplastic anemia,leukemia,hemophilia,thrombocytopenic purpura and other blood system diseases were excluded,and the patients who were abandoned by their families within one week of admission were excluded.Thirty-one patients with cerebral hemorrhage associated with antithrombotic drugs（including antiplatelet aggregation,anticoagulation and thrombolysis）were selected as the experimental group and 30 non-ATT-ICH patients admitted at the same time as the control group.Baseline information was collected,including sex,age,history of hypertension,smoking history,Systolic Blood Pressure（SBP）,and Diastolic Blood Pressure（DBP）at admission.At admission,the Glasgow Scale（GCS）was used to record the first relevant laboratory indicators of all patients:Blood Platelet Count（BPC）,International Normalized Ratio（INR）,Activated Partial Thromboplatin Time（APTT）,Prothrombin time（PT）;according to the hematoma morphology classification proposed by Barras et al.^[15]in 2009,the hematoma morphology of the experimental group and the control group was recorded;all the hematoma sites were recorded;and the use of more blood was increased.Tian formula calculates hematoma volume（cm³）=A x B x C xπ/6.A is the long axis of the plane of the maximum area of head CT hematoma,B is the length of the shortest axis of the maximum area of hematoma（required to be perpendicular to A）,and C is the number of scanning layers of hematoma.The volume of blood in the ventricle or sylvian fissure cistern was not calculated in the volume of hematoma.The volume of hematoma was recorded for 6hours,24±3h,72h and 7d after onset,and the changes of hematoma morphology and hematoma were compared and analyzed.SPSS 21.0 statistical software was used for data analysis.Measurement data were expressed as±s and independent sample t test was used for inter-group comparison.The counting data were expressed by percentage（n,%）and x²test was used for comparison between groups,with statistical significance expressed by P<0.05.Results（1）Among 31 cases of antithrombotic drug-related intracerebral hemorrhage,26 cases were aspirin-related intracerebral hemorrhage,2 cases were warfarin-related intracerebral hemorrhage,and 3 cases were hemorrhagic transformation after intravenous thrombolysis.Because there were few cases of warfarin-related intracerebral hemorrhage and hemorrhagic transformation after intravenous thrombolysis,the main purpose of this study was to study the hematoma morphology and hematoma of aspirin-related intracerebral hemorrhage and non-ATT-IC The changes of location and volume of hematoma showed significant difference between aspirin-related cerebral hemorrhage and non-ATT-ICH in irregular hematoma（65%vs36%,P<0.05）.There was no significant difference between aspirin-related cerebral hemorrhage and non-ATT-ICH in basal ganglia,thalamus,cerebral lobe,cerebellum and brain stem（P>0.05）.（2）The results of the study are as follows:1)The results of the study are as follows:1)The results of the study are as follows:1)The results of the study are as follows:1.（2）In terms of hematoma absorption rate,there was no significant difference between aspirin-related cerebral hemorrhage and non-ATT-ICH at 24±3h of onset（0.10±0.10 vs 0.06±0.06,P>0.05）,and there was significant difference between the two groups at 72h and 7d（0.29±0.15 vs 0.21±0.08 P<0.05,0.65±0.21 vs 0.52±0.19P<0.05）.（3）In terms of hematoma growth,there were significant differences between aspirin-related cerebral hemorrhage group and non-ATT-ICH group in the volume of hematoma at 24±3h and 72h of onset（41.33±19.37 vs 14.85+9.78 P<0.01,34.62±10.51 vs 13.91±10.63 P<0.01）.Conclusion（1）The hematoma morphology of aspirin-related cerebral hemorrhage was mainly irregular（65%）.（2）In patients with aspirin-related intracerebral hemorrhage,the volume of hematoma increased from 24 to 72 hours after onset.The absorption rate of aspirin-related cerebral hemorrhage was faster in 72 h to 7 d than in non-ATT-ICH patients.