Avoiding central nervous system bleeding during antithrombotic therapy : Recent data and ideas

Approximately 7000 intracerebral hemorrhages (ICHs) annually in the US are caused by use of antithrombotic therapies. We review the incidence, risk factors, and predictors of ICH in patients receiving long-term anticoagulation or antiplatelet therapy. ICH rates range from 0.3% to 0.6% per year durin...

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Bibliographic Details
Published in:Stroke (1970) 2005-07, Vol.36 (7), p.1588-1593
Main Authors: HART, Robert G, TONARELLI, Silvina B, PEARCE, Lesly A
Format: Article
Language:English
Subjects:
Administration, Oral
Age Factors
Aged
Anticoagulants - therapeutic use
Aspirin - pharmacology
Atrial Fibrillation
Biological and medical sciences
Blood Pressure
Brain Ischemia - pathology
Cerebral Hemorrhage - prevention & control
Clinical Trials as Topic
Female
Fibrinolytic Agents - pharmacology
Humans
International Normalized Ratio
Male
Medical sciences
Metabolic diseases
Middle Aged
Neurology
Other metabolic disorders
Pigments (porphyrias, hyperbilirubinemias...)
Platelet Aggregation Inhibitors - pharmacology
Risk Factors
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
Ticlopidine - analogs & derivatives
Ticlopidine - pharmacology
Vascular diseases and vascular malformations of the nervous system
Warfarin - pharmacology
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Summary:Approximately 7000 intracerebral hemorrhages (ICHs) annually in the US are caused by use of antithrombotic therapies. We review the incidence, risk factors, and predictors of ICH in patients receiving long-term anticoagulation or antiplatelet therapy. ICH rates range from 0.3% to 0.6% per year during oral anticoagulation in recent reports. Major risk factors are advanced patient age, elevated blood pressure, intensity of anticoagulation, and previous cerebral ischemia. Combining antiplatelet agents with anticoagulation and the combined use of aspirin plus clopidogrel appear to increase ICH risk. Modest blood pressure-lowering halves the frequency of ICH during antiplatelet therapy. ICH is an uncommon, but often fatal, complication of antithrombotic therapy that particularly afflicts patients with previous stroke. Recent data support that keeping international normalized ratio < or =3.0, control of hypertension, and avoiding the combination of aspirin with warfarin reduce its frequency.
ISSN:0039-2499
1524-4628
DOI:10.1161/01.STR.0000170642.39876.f2