Intracerebral hemorrhages associated with neurointerventional procedures using a combination of antithrombotic agents including abciximab.
BACKGROUND
We report the occurrence of fatal intracerebral hemorrhage associated with using a combination of antithrombotic agents, including abciximab, in patients undergoing neurointerventional procedures.


METHODS
Seven patients (average age 60, range 46 to 73 years) developed fatal intracerebral hemorrhages associated with neurointerventional procedures and the use of intravenous abciximab. The procedures included angioplasty and stent placement in the cervical internal carotid artery (n=4), angioplasty of the intracranial internal carotid artery (n=1), and angioplasty of the middle cerebral artery (n=2). Clinical deterioration was observed within 1 hour of the procedure in 5 patients and 7 and 8 hours after the procedure, respectively, in the remaining 2 patients. All patients had received heparin and clopidogrel; 6 had also received aspirin.


CONCLUSIONS
Intracerebral hemorrhages can occur after neurointerventional procedures in patients with recent cerebral ischemic events, particularly when aggressive antithrombotic treatment is used.
Qureshi
Adnan I
AI
Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA. aiqureshi@hotmail.com
Saad
Mustafa
M
Zaidat
Osama O
OO
Suarez
Jose I
JI
Alexander
Michael J
MJ
Fareed
M
M
Suri
K
K
Ali
Zulfiqar
Z
Hopkins
L Nelson
LN
D000077284:Abciximab; D000046:Academic Medical Centers; D000368:Aged; D017130:Angioplasty / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D000925:Anticoagulants / Q000008:administration & dosage; D002340:Carotid Artery Diseases / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage / Q000009:adverse effects*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D015607:Stents; D014057:Tomography, X-Ray Computed
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D005343:Fibrinolytic Agents; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab