Abstract Body: Introduction: Celecoxib, a selective cyclooxygenase-2 (COX-2) inhibitor, has been shown to reduce perihematomal edema in patients with acute intracerebral hemorrhage (ICH), but its effect on outcome was largely unclear. This study aimed to evaluate the effects of COX inhibitors (COXi) on patients with acute ICH.
Methods: This study retrospectively enrolled patients with acute ICH hospitalized in our Hospital between Jan. 2015 and Dec. 2020. The exclusion criteria were delayed hospitalization for more than 10 days, transferal to other hospital within 10 days, ICH etiologies as trauma, structural lesion, medication, or systemic diseases. Although aspirin belongs to COXi, aspirin users were excluded because of the antiplatelet effect. Patients with continuous usage of COXi for at least three days were defined as COXi users. The effects of using COXi before or after ICH were analyzed individually. Good functional outcome was defined as modified Rankin Scale score 0-2 at 3 months.
Results: A total of 1,022 patients were enrolled, in whom 35 (3.4%) used COXi within 2 weeks before ICH while 154 (15.1%) used COXi within 4 weeks after ICH. Patients using COXi before ICH were older, had a lower hemoglobin level, and more lobar hematoma. Patients using COXi after ICH were younger, had a lower NIHSS score, and higher percentage of operation. In multivariate logistic regression models, using COXi before ICH was associated with a higher mortality risk [using within 1 week: adjusted odds ratio (aOR) 3.20, 95% CI (1.13, 9.06), p = 0.028; within 2 weeks, aOR 2.78, 95% CI (1.03, 7.51), p = 0.044]. On the contrary, using COXi after ICH was associated with a lower mortality risk [using within 3 weeks: aOR 0.45, 95% CI (0.23. 0.87), p = 0.018; within 4 weeks, aOR 0.44, 95% CI (0.23, 0.84), p = 0.013]. The usage of COXi after ICH was associated with a good functional outcome specifically in patients with a non-operated lobar hematoma [OR 2.75, 95% CI (1.16, 6.54), p = 0.022], and in those with a non-operated smaller hematoma (<30 mL) [OR 1.65, 95% CI (1.01, 2.70), p = 0.047]. Furthermore, ICH etiology of amyloid angiopathy was significantly associated with pre-ICH usage of COXi [aOR 2.90, 95% CI (1.36, 6.17), p = 0.006].
Conclusions: This study demonstrated different effects of COXi usage before and after ICH on long-term functional outcome and mortality in patients with acute ICH, specifically depending on hematoma location, volume, and operation.