Avoiding central nervous system bleeding during antithrombotic therapy: recent data and ideas.
BACKGROUND
Approximately 7000 intracerebral hemorrhages (ICHs) annually in the US are caused by use of antithrombotic therapies. We review the incidence, risk factors, and predictors of ICH in patients receiving long-term anticoagulation or antiplatelet therapy.


RESULTS
ICH rates range from 0.3% to 0.6% per year during oral anticoagulation in recent reports. Major risk factors are advanced patient age, elevated blood pressure, intensity of anticoagulation, and previous cerebral ischemia. Combining antiplatelet agents with anticoagulation and the combined use of aspirin plus clopidogrel appear to increase ICH risk. Modest blood pressure-lowering halves the frequency of ICH during antiplatelet therapy.


CONCLUSIONS
ICH is an uncommon, but often fatal, complication of antithrombotic therapy that particularly afflicts patients with previous stroke. Recent data support that keeping international normalized ratio < or =3.0, control of hypertension, and avoiding the combination of aspirin with warfarin reduce its frequency.
Hart
Robert G
RG
Department of Medicine, University of Texas Health Science Center, San Antonio, TX 78229-3900, USA. hartr@uthscsa.edu
Tonarelli
Silvina B
SB
Pearce
Lesly A
LA
D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000494:pharmacology; D001281:Atrial Fibrillation; D001794:Blood Pressure; D002545:Brain Ischemia / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D005260:Female; D005343:Fibrinolytic Agents / Q000494:pharmacology*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology; D012307:Risk Factors; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000494:pharmacology; D014859:Warfarin / Q000494:pharmacology
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin