Title: Aspirin and anticoagulant usage on outcomes after ruptured arteriovenous malformation: a Nationwide Inpatient Sample analysis
Background: Recently in nationwide study, neither long-term aspirin nor anticoagulant use were associated with differential mortality or complication rates after aneurysmal subarachnoid hemorrhage however their impact on outcomes of ruptured arteriovenous malformation is unclear.
Methods: Data from the Nationwide Inpatient Sample (NIS; 2006–2014) were analyzed in patients with a primary diagnosis of SAH and/or ICH with a diagnosis of an arteriovenous malformation. These patients were divided in two groups: receiving long-term aspirin or anticoagulant use versus neither. Multivariable logistic regression was performed to calculate the adjusted odds of in-hospital mortality, a nonroutine discharge (any discharge other than to home), or a poor outcome (death, discharge to institutional care, tracheostomy, or gastrostomy) for patients with long-term aspirin or anticoagulant use. Multivariable linear regression was used to evaluate length of hospital stay. Covariates included patient demographics, comorbidities, APDRG severity scale, and treatment of AVM including embolization, surgical resection and radiosurgery.
Results: Our study examined 11066 patients with ruptured AVM. Patients taking either aspirin (2.5 %, n =273) or anticoagulation (1.7 %, n =185) were significantly older and had a greater burden of comorbid disease (hypertension, hyperlipidemia, atrial fibrillation and renal disease, p < 0.001). Inpatient mortality (10.9 % either aspirin/anticoagulation vs 9.2 % neither, p = 0.63) Length of stay (9.3 ± 8.7 days vs 11.0 ± 13.5 days p = 0.11) were not significantly different. In multivariable logistic regression models for outcome, discharge disposition was better in ASA/Anticoagulation group (home discharge OR 2.36, CI 1.40-3.98, p = 0.001) but inpatient mortality was not different (OR 0.79, CI 0.34-1.82, p=0.58).
Conclusion: In this nationwide study, neither long-term aspirin nor anticoagulant use was associated with differential mortality after ruptured arteriovenous malformation. Aspirin/anticoagulant use was associated with favorable discharge to home.