title: Spontaneous subdural hematoma and antiplatelet therapy: Does efficacy of Ticagrelor come with added risk?
abstract: Antiplatelet therapy has established clinical benefit on cardiovascular outcome and has reduced the rates of re-infarction/in stent thrombosis following percutaneous coronary intervention in acute coronary syndromes. Major bleeding episodes can occur with antiplatelet therapy and intracranial hemorrhage (ICH) is one of the most feared complications resulting in significant morbidity and mortality. Identification of high risk groups and judicious use of antiplatelet therapy reduces the bleeding risk. Ticagrelor is a newer P2Y12 receptor antagonist with established clinical benefit. However, risks of having an ICH with these newer molecules cannot be ignored. Here, we report a case of spontaneous acute subdural hematoma developing in a patient on antiplatelet therapy with aspirin and ticagrelor. Early recognition, discontinuation of the medication and appropriate management resulted in resolution of hematoma and good clinical outcome. Authors have reviewed the antithrombotic drugs and their tendencies in causing intracranial bleeds from a neurophysicians perspective.
authors.affiliation: Senior Resident, Department of Neurology, M.S. Ramaiah Medical College, Bangalore 560054, India. Electronic address: Pmssharma17@gmail.com.
authors.forename: Pattanagere Manjunatha
authors.initials: PM
authors.lastname: Suryanarayana Sharma
authors.affiliation: Associate Professor of Neurosurgery, M.S. Ramaiah Medical College, Bangalore 560054, India.
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Tekkatte Jagannatha
authors.affiliation: Associate Professor of Neurology, M.S. Ramaiah Medical College, Bangalore 560054, India.
authors.forename: Mahendra
authors.initials: M
authors.lastname: Javali
authors.affiliation: Assistant Professor of Cardiology, M.S. Ramaiah Medical College, Bangalore 560054, India.
authors.forename: Anupama Venkatasubba
authors.initials: AV
authors.lastname: Hegde
authors.affiliation: Assistant Professor of Neurology, M.S. Ramaiah Medical College, Bangalore 560054, India.
authors.forename: Rohan
authors.initials: R
authors.lastname: Mahale
authors.affiliation: Senior Resident, Department of Neurology, M.S. Ramaiah Medical College, Bangalore 560054, India.
authors.lastname: Madhusudhan
authors.affiliation: Senior Professor & Head, Department of Neurology, M.S. Ramaiah Medical College, Bangalore 560054, India.
authors.forename: Rangasetty
authors.initials: R
authors.lastname: Srinivasa
mesh_terms: D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives*; D015415:Biomarkers / Q000032:analysis; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000628:therapy*; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004452:Echocardiography; D004562:Electrocardiography; D006408:Hematoma, Subdural / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects*; D015607:Stents; D000077486:Ticagrelor; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D058921:Purinergic P2Y Receptor Antagonists; D000077486:Ticagrelor; D000241:Adenosine
keywords: Acute coronary syndrome; Antiplatelet therapy; Intracranial hemorrhage; Subdural hematoma; Ticagrelor