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

• 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
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000170642.39876.f2

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.