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World Neurosurg. 2016 Oct;94:453-457. doi: 10.1016/j.wneu.2016.07.019. Epub 2016 Jul 15.

Analysis of Hemorrhage Volumes After Angiogram-Negative Subarachnoid Hemorrhage.

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Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA. Electronic address:
Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA.



Antiplatelet medication use is associated with worsened outcome after angiogram-negative subarachnoid hemorrhage (SAH). It has been hypothesized that these worsened outcomes may be the result of an association between antiplatelet medication use and increased hemorrhage volumes after angiogram-negative SAH. To test this hypothesis, we performed volumetric analysis of computed tomography (CT)-defined hemorrhage after angiogram-negative SAH.


This was a retrospective analysis of patients presenting with nontraumatic, angiogram-negative SAH in the Columbia University Subarachnoid Hemorrhage Outcomes database between 2000 and 2013. SAH volumes on admission head CT scans were measured using the MIPAV software package, version 7.20 in a semiautomated fashion.


A total of 108 presenting CT scans from patients with angiogram-negative SAH were analyzed. The mean hemorrhage volume was 14.3 mL in the patients with a history of antiplatelet medication use, compared with 6.8 mL in those with no history of antiplatelet use. This difference was found to be significant (P = 0.0029).


Antiplatelet medication use is associated with increased SAH volumes in patients with angiogram-negative SAH. Increased hemorrhage volumes may contribute to poor outcomes in this patient population. Prospective studies are warranted to confirm this association.


Aneurysm; Aspirin; Clopidogrel; Intracranial hemorrhage; Stroke

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