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Use of antithrombotic agents in patients with intracerebral cavernous malformations
Kelly D Flemming1, Michael J Link, Teresa J H Christianson
1Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA. flemming.kelly@mayo.edu
Insights
Antithrombotic agents appear safe for most patients with intracerebral cavernous malformations (ICMs). However, careful consideration of hemorrhage risk is crucial for high-risk individuals when prescribing these medications.
Area of Science:
- Neurology
- Vascular Medicine
- Pharmacology
Background:
- Intracerebral cavernous malformations (ICMs) are vascular anomalies.
- The use of antithrombotic agents in patients with ICMs raises safety concerns regarding hemorrhage risk.
Purpose of the Study:
- To evaluate the risk of hemorrhage associated with antithrombotic agent use in patients diagnosed with intracerebral cavernous malformations (ICMs).
Main Methods:
- A cohort of 292 patients with radiographically confirmed ICMs was reviewed.
- Forty patients requiring antithrombotic therapy post-diagnosis were followed to assess hemorrhage incidence.
Main Results:
- Among 40 patients on antithrombotics (mean age 62.4 years), only one experienced a prospective hemorrhage (0.41% per person-year).
- Patients received antiplatelets (n=32), anticoagulants (n=6), or both (n=2).
- Initial presentation included hemorrhage in 12.5% and multiple ICMs in 10% of patients.
Conclusions:
- Antithrombotic therapy is unlikely to precipitate hemorrhage in patients with established ICMs.
- Caution is advised for high-risk ICM patients; risks and benefits must be weighed against the natural disease history.
Object:
The goal of this study was to determine the risk of using antithrombotic agents in patients with established intracerebral cavernous malformations (ICMs).
Methods:
From a previously described cohort of 292 patients with radiographically defined ICMs, 40 required an antithrombotic after the ICM was diagnosed. Patients underwent follow-up to determine the incidence of hemorrhage.
Results:
The mean age of these 40 patients was 62.4 years; there were 21 male and 19 female patients. Five (12.5%) of the 40 patients initially presented with hemorrhage and 4 (10%) had multiple ICMs. Of these patients, 32 were placed on an antiplatelet agent alone, 6 on an anticoagulant alone, and 2 were placed on both. In patients necessitating any antithrombotic agent, 1 patient developed a prospective hemorrhage over the 258 person-years of follow-up (prospective hemorrhage rate 0.41% per person-year).
Conclusions:
Antithrombotics likely do not precipitate hemorrhage in patients with known ICMs. However, caution should be exercised in the use of antithrombotics in patients with ICMs at high risk for hemorrhage. The risks and benefits of antithrombotics in each situation should be carefully weighed against the natural history of ICM.
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