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Intracranial Hemorrhage Risk in the Era of Antithrombotic Therapies for Ischemic Stroke

  • Cerebrovascular Disease and Stroke (N Rost, Section Editor)
  • Published:
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Opinion statement

Intracranial hemorrhage (ICH) is the most feared complication of antithrombotic medication use for the treatment and prevention of ischemic stroke. The risk of ICH while on blood thinners varies not only among different types of antithrombotics but also for the same agent used in different patient populations. Individual patients have different susceptibilities to ICH mostly due to the presence or absence of bleeding-prone cerebral pathologies such as cerebral amyloid angiopathy or hypertensive small vessel disease. The recent development and FDA approval of novel anticoagulants may lead to increased safety when compared to previously used medications, and the emergence of nonpharmacologic approaches may obviate the need for long-term anticoagulant strategies in certain clinical situations, such as left atrial appendage closure for stroke prevention in atrial fibrillation. As such, blanket recommendations for antithrombotic choice cannot be justified. Good practices in vascular neurology dictate combining all available data in order to choose the treatment that has the best risk-benefit ratio for each individual patient.

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Acknowledgments

This work was made possible by the following NIH grant: K23 NS083711.

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Authors and Affiliations

  1. Department of Neurology, Massachusetts General Hospital, Boston, MA, USA

    Jesse M. Thon MD & M. Edip Gurol MD, MSc

  2. Massachusetts General Hospital, Hemorrhagic Stroke Research Program, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA

    M. Edip Gurol MD, MSc

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  1. Jesse M. Thon MD
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Correspondence to M. Edip Gurol MD, MSc.

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All cited studies by M. Edip Gurol involving human subjects were performed after approval by the appropriate institutional review boards. When required, written informed consent was obtained from all participants.

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This article is part of the Topical Collection on Cerebrovascular Disease and Stroke

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Thon, J.M., Gurol, M.E. Intracranial Hemorrhage Risk in the Era of Antithrombotic Therapies for Ischemic Stroke. Curr Treat Options Cardio Med 18, 29 (2016). https://doi.org/10.1007/s11936-016-0453-y

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