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Antithrombotic therapy and intracranial bleeding in subjects with sporadic brain arteriovenous malformations: preliminary results from a retrospective study

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Abstract

Whether antithrombotic treatment is safe and/or affects the risk of intracranial bleeding in subjects with sporadic brain arteriovenous malformations (AVMs) is unknown. We conducted a retrospective analysis on the use of antithrombotics among patients affected by brain AVMs in follow-up at our institution. Attention was paid to the type of antithrombotic drug (either antiplatelets or anticoagulants), current or past use, dosage, and duration of treatment. Several clinical and angioarchitectural features of brain AVMs were also taken into consideration. The association between the use of antithrombotics and haemorrhagic onset was analyzed. A total of 77 patients were included in this study. Among them, ten patients were taking antithrombotic drugs at the time of AVM diagnosis. The rate of haemorrhagic onset was not significantly different between subjects who were and were not taking antithrombotic drugs (40 vs 55.2%, p = ns). Among the many clinical and angioarchitectural features analyzed, the only parameter that showed a statistically significant association with haemorrhagic onset was the size of the nidus. Patients who took antithrombotic treatments after being diagnosed with a brain AVM did not show an increased rate of intracranial haemorrhage over time considering a mean follow-up 4 years. In our study, antithrombotic treatment was not associated with increased intracranial bleeding among subjects with brain AVMs. In the presence of a strong clinical indication, antiplatelet and anticoagulant medications should not be denied a priori to patients with brain AVMs. Studies on larger populations are necessary to confirm these data.

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Authors and Affiliations

  1. Institute of Neurosurgery, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy

    Carmelo Lucio Sturiale, Fabrizio Pignotti, Alessio Albanese, Alfredo Puca & Alessandro Olivi

  2. Institute of Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Marzia Giordano, Angelo Porfidia, Igor Giarretta, Eleonora Gaetani, Ada Truma & Roberto Pola

  3. Institute of Anesthesiology and Intensive Care, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Sonia D’Arrigo

Authors
  1. Carmelo Lucio Sturiale
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  2. Fabrizio Pignotti
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  3. Marzia Giordano
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  4. Angelo Porfidia
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  5. Alessio Albanese
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  6. Igor Giarretta
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  7. Alfredo Puca
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  8. Eleonora Gaetani
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  9. Sonia D’Arrigo
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  10. Ada Truma
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  11. Alessandro Olivi
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  12. Roberto Pola
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Consortia

Sporadic AVMs-HHT Study Group

Contributions

All authors have read and approved the submitted manuscript; it has not been submitted elsewhere nor published elsewhere in whole or in part. There are no competing interests.

Corresponding author

Correspondence to Carmelo Lucio Sturiale.

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The authors declare that they have no conflict of interest.

Statement of human and animal rights

The protocol was conducted in agreement with the Helsinki declaration. This dataset is completely anonymous and does not contain any identifiable personal data.

Informed consent

Informed consent was obtained from all individual participants included in the study at the time of their hospital admission.

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Sturiale, C.L., Pignotti, F., Giordano, M. et al. Antithrombotic therapy and intracranial bleeding in subjects with sporadic brain arteriovenous malformations: preliminary results from a retrospective study. Intern Emerg Med 13, 1227–1232 (2018). https://doi.org/10.1007/s11739-018-1918-7

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  • DOI: https://doi.org/10.1007/s11739-018-1918-7

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