News from IMIM
An aspirin may seem innocuous, but in patients suffering from cerebral haemorrhage, the risk of death may increase up to three times. This is demonstrated by two studies that have analyzed, respectively, 529 and 197 patients that suffered cerebral hemorrhage, about half of which were taking antithrombotics - aspirin or Sintrom - when they experienced the bleeding. Mortality within 24 hours after the accident was 19% in patients who were in antiplatelet treatment (aspirin) and 27% for vitamin K antagonist treatments (Sintrom). By contrast, only 6.5% of those who received no previous treatment died.
According to the authors, this risk increase is probably due to the fact that intracranial haemorrhages increase in volume faster in the presence of antithrombotics. In fact, the second study, which focused on looking at the volume of the hematoma in the first 6 hours, showed that it was more than double in patients with antithrombotic treatments compared to those with no treatment. This may explain the failure of the treatments that reverse the antithrombotic effect in these patients, since despite their rapid arrival to hospital, the volume of their brain haemorrhages is already very large.
"Although antithrombotic drugs are very useful, they should not be prescribed unless clearly indicated," says the first author of the two articles, Jaume Roquer, who is head of the Neurology Department of the Hospital del Mar and coordinator of neurovascular research at the IMIM. The researchers recommend, in particular, not prescribing antiaggregants in patients with atrial fibrillation, due to the risk of serious complications - MM/PRBB
IMIM website (in Catalan)
Roquer J, Vivanco Hidalgo RM, Ois A, Rodríguez Campello A, Cuadrado Godia E, Giralt Steinhauer E, Gómez González A, Soriano Tarraga C, Jiménez Conde J. Antithrombotic pretreatment increases very-early mortality in primary intracerebral hemorrhage. Neurology. 2017;88:885-891. doi:10.1212/WNL.0000000000003659. PMID: 28148636.
Roquer J. Vivanco-Hidalgo R, Capellades J, Ois A, Cuadrado-Godia E, Giralt-Stainhauer E, Soriano-Tárraga C, Mola-Caminal, M, Serra-Martínez M, Avellaneda-Gómez C, Jiménez-Conde J, Rodríguez-Campello A. Ultra-early hematoma growth in antithrombotic pretreated patients with intracerebral hemorrhage. Eur J Neurol. 2017. 2017 Sep 14. doi: 10.1111/ene.13458. PMID: 28906578