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Antiplatelet and anticoagulation therapy and the risk of pituitary apoplexy in pituitary adenoma patients

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Abstract

Purpose

Pituitary apoplexy can be a life threatening and vision compromising event. Antiplatelet and anticoagulation use has been reported as a contributing factor in pituitary apoplexy (PA). Utilizing one of the largest cohorts in the literature, this study aims to determine the risk of PA in patients on antiplatelet/anticoagulation (AP/AC) therapy.

Methods

A single center, retrospective study was conducted on 342 pituitary adenoma patients, of which 77 patients presented with PA (23%). Several potential risk factors for PA were assessed, including: patient demographics, tumor characteristics, pre-operative hormone replacement, neurologic deficits, coagulation studies, platelet count, and AP/AC therapy.

Results

Comparing patients with and without apoplexy, there was no significant difference in the proportion of patients taking aspirin (45 no apoplexy vs. 10 apoplexy; p = 0.5), clopidogrel (10 no apoplexy vs. 4 apoplexy; p = 0.5), and anticoagulation (7 no apoplexy vs. 3 apoplexy; p = 0.7). However, male sex (p-value < 0.001) was a predictor for apoplexy while pre-operative hormone treatment was a protective factor from apoplexy (p-value < 0.001). A non-clinical difference in INR was also noted as a predictor for apoplexy (no apoplexy: 1.01 ± 0.09, apoplexy: 1.07 ± 0.15; p < 0.001).

Conclusions

Although pituitary tumors have a high risk for spontaneous hemorrhage, the use of aspirin is not a risk for hemorrhage. Our study did not find an increased risk of apoplexy with clopidogrel or anticoagulation, but further investigation is needed with a larger cohort. Confirming other reports, male sex is associated with an increased risk for PA.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA

    Bronson Ciavarra & Timothy McIntyre

  2. The Vivian L Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA

    Matthew J. Kole & Spiros L. Blackburn

  3. Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA

    Wen Li

  4. Department of Otorhinolaryngology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA

    William Yao

  5. Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA

    Katie B. Guttenberg

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  1. Bronson Ciavarra
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Contributions

BC, TM, and MJK collected and evaluated the clinical and imaging data. WL performed the statistical analysis. The first version of the manuscript was drafted by BC. BC, MJK, WY, KBG, and SBL conceptualized the study. All authors discussed the dataset from their interdisciplinary perspective and participated in the revision and editing of the manuscript.

Corresponding author

Correspondence to Spiros L. Blackburn.

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Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Institutional Review Board approval was obtained from The University of Texas Health Science Center Committee for the Protection of Human Subjects (HSC-MS-19-0697).

Consent

Due to the retrospective nature of this study, informed consent was waived by the Institutional Review Board.

Competing interests

No authors have any financial or non-financial interests that are directly or indirectly related to this work.

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Ciavarra, B., McIntyre, T., Kole, M.J. et al. Antiplatelet and anticoagulation therapy and the risk of pituitary apoplexy in pituitary adenoma patients. Pituitary 26, 375–382 (2023). https://doi.org/10.1007/s11102-023-01316-5

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