Intracerebral Hemorrhages Associated With Neurointerventional Procedures Using a Combination of Antithrombotic Agents Including Abciximab

TLDR

Fatal intracerebral hemorrhage has been reported in patients undergoing neurointerventional procedures while receiving a combination of antithrombotic agents, including abciximab. The procedures comprised cervical and intracranial carotid artery angioplasty and stenting, with all patients receiving heparin and clopidogrel and most also aspirin. Seven patients (average age 60) suffered fatal intracerebral hemorrhages within hours of the procedures, demonstrating that aggressive antithrombotic therapy can precipitate hemorrhage after recent cerebral ischemic events.

Abstract

Background — We report the occurrence of fatal intracerebral hemorrhage associated with using a combination of antithrombotic agents, including abciximab, in patients undergoing neurointerventional procedures. Summary of Report — 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.