Antithrombotic medication and bleeding risk in patients with cerebral cavernous malformations: a cohort study.

Bervini, David; Jaeggi, Christian; Mordasini, Pasquale; Schucht, Philippe; Raabe, Andreas (2018). Antithrombotic medication and bleeding risk in patients with cerebral cavernous malformations: a cohort study. Journal of neurosurgery, 130(6), pp. 1922-1930. American Association of Neurological Surgeons 10.3171/2018.1.JNS172547

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OBJECTIVE Cerebral cavernous malformations (CCMs) are frequently diagnosed vascular abnormalities. The hemorrhagic risk associated with the use of long-term antithrombotic medication (ATM) in patients with CCMs is a matter of controversy. The aim of this study was to determine the hemorrhagic risk associated with ATM use in patients diagnosed with one or more CCMs. METHODS Demographic, clinical, treatment, and ATM-related information on patients diagnosed with one or more CCMs at a single institution over more than 34 years was retrospectively recorded. Univariate and multivariate descriptive and survival analyses were used to assess potential risk factors associated with CCM-related hemorrhage at presentation and during follow-up (first or subsequent hemorrhage). RESULTS A total of 408 patients were included in the analysis and 492 CCMs were followed up after diagnosis, for a total of 1616 lesion-years. Thirty-seven (7.5%) CCMs bled during follow-up, leading to an overall annual rate of CCM-related symptomatic hemorrhage of 2.3% (95% CI 1.7%-3.2%). Eighty-two patients harboring 91 CCMs (16.8%) were on ATM. When stratified for ATM, the annual rates of hemorrhage were 0.7% (95% CI < 0.01% to 4.2%) for the lesions in patients on ATM versus 2.5% (95% CI 1.8%-3.4%) for those not on ATM. ATM was not found to be associated with either an increased risk of CCM-related hemorrhage at presentation (p = 0.355) or an increased risk of CCM-related hemorrhage (first or subsequent hemorrhage) in multivariate descriptive (p = 0.912) and survival (p = 0.145) analyses. CONCLUSIONS The use of ATM does not seem to be associated with an increased risk of hemorrhage in patients diagnosed with CCMs.

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