Prophylactic Anticonvulsants in Intracerebral Hemorrhage (P3.098)

Objective: To characterize prophylactic anticonvulsant (PA) use following intracerebral hemorrhage (ICH). Background: The 2010 ICH guidelines recommend that patients without seizures should not receive PAs, but guideline adherence data are scarce. PAs increase costs and have been associated with poorer patient outcomes. We sought to characterize the prevalence and predictors of PA use after ICH. Design/Methods: We performed a retrospective study of primary ICH in our institution in 2009-2011. Cases were identified by ICD-9 code and verified by physician review. Demographic data, vascular risk factors, imaging characteristics, processes of care, and short-term outcomes were ascertained. We performed multiple logistic regression to determine independent predictors of PA initiation. Results: We identified 424 patients with primary ICH; 26 patients with a previous history of seizures were excluded. Of the remaining 398, 16 (4[percnt]) had a seizure prior to discharge. Overall, 65/382 (17[percnt]) patients were started on PAs. Of 240 patients admitted prior to ICH guideline publication in July 2010, 45 (18.4[percnt]) were given PAs compared with 20 of 142 (14.1[percnt]) after (p=0.24). Levetiracetam was the PA used in 63 of 65 (96.9[percnt]) cases; 22 (33.8[percnt]) patients were discharged from the hospital with a PA. Younger age, lower GCS, higher NIHSS, higher ICH volume, subarachnoid extension, lobar location, and craniotomy were associated with PA use in univariate analysis. In the regression analysis age (0.968 [95[percnt] CI 0.962, 0.974], p<0.0001) and ICH volume (1.019 [95[percnt] CI 1.010, 1.028], p<0.0001) were independently associated with PA initiation. Discussion: A substantial proportion of our ICH patients received PAs and there was no significant change in clinical practice after guideline publication. Younger age and higher ICH volume independently predicted PA initiation. Future investigation should examine the impact of PAs on patient outcomes and cost. Study supported by: IUSM/IUH SRI, IU CTSI PDT, and IUH Values Fund. Disclosure: Dr. Mackey has received personal compensation in an editorial capacity for Seminars in Neurology. Dr. Blatsioris has nothing to disclose. Dr. Moser has nothing to disclose. Dr. Carter has nothing to disclose. Dr. Reagan Secrest has nothing to disclose. Dr. Hulin has nothing to disclose. Dr. O9Neill has nothing to disclose. Dr. Cohen-Gadol has nothing to disclose. Dr. Leipzig has nothing to disclose. Dr. Williams has nothing to disclose.