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Antithrombotic therapy and bleeding risk in a prospective cohort study of patients with cerebral cavernous

Hans-Martin Schneble1, Aicha Soumare, Dominique Hervé

  • 1Department of Neurology, APHP-Hôpital Lariboisière, and Univ Paris Diderot-Sorbonne Paris Cité, 2 rue Ambroise Paré, 75475 Paris cedex 10, France.

Stroke
|November 15, 2012
PubMed

Insights

Antithrombotic therapy, including antiplatelet drugs or warfarin, appears safe for patients with cerebral cavernous malformations (CCMs). This study found no increased risk of CCM-related hemorrhage in patients undergoing antithrombotic treatment.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Neurosurgery

Background:

  • Cerebral cavernous malformations (CCMs) are common brain vascular malformations.
  • CCMs can cause intracranial hemorrhage.
  • Antithrombotic therapy is often avoided in CCM patients due to hemorrhage concerns, despite a lack of supporting studies.

Purpose of the Study:

  • To evaluate the safety of antithrombotic therapy in patients with cerebral cavernous malformations.
  • To determine if antiplatelet or anticoagulant use increases hemorrhage risk in CCM patients.

Main Methods:

  • Prospective follow-up of 87 consecutive CCM patients since 2008.
  • Retrospective data collection for pre-enrollment events.
  • Defined symptomatic hemorrhage and neurological events per Angioma Alliance guidelines.

Main Results:

  • 16 out of 87 patients received long-term antithrombotic therapy (11 antiplatelet, 5 anticoagulants).
  • During 5536 lesion-years of follow-up, no patients on antithrombotic therapy experienced CCM hemorrhage.
  • The cohort included patients with single or multiple CCMs.

Conclusions:

  • Long-term antithrombotic treatment with antiplatelet drugs or warfarin does not appear to increase CCM-related hemorrhage frequency.
  • CCM patients with ischemic stroke or heart disease should not be denied antithrombotic therapy.
Abstract

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