In a nutshell
Many physicians are reluctant to use antithrombotics once hemorrhagic transformation (HT) has occured in ischemic stroke. Antithrombotics are believed to be associated with worsening HT and consequent neurological deterioration (decreased mental ability). This study investigated whether this association was true.
Some background
Stroke is a sudden brain dysfunction caused by blood flow disturbances in the brain. Strokes can either be ischemic, which is caused by a blood clot in the brain, or hemorrhagic, which is caused by bleeding via burst blood vessel. Both types of stroke prevent oxygen and food reaching the brain tissue, thus causing cell death.
HT is caused when the ischemic stroke becomes “hemorrhagic” i.e. bleeding occurs within the dying ischemic brain tissue. Antithrombotics (e.g. antiplatelets, warfarin) are recommended for hemorrhagic strokes as they prevent the blood from clumping which can cause blood clots. However, many physicians will not use antithrombotics to treat HT in ischemic strokes as there are no appropriate guidelines or clinical studies about their use in HT.
Methods & findings
This study compared the use of antiplatelets and warfarin in HT after ischemic stroke.
This study examined 222 patients (average age of 70 years) with ischemic stroke and HT. They analysed the relationships between antithrombotics, HT and neurological deterioration.
Results showed that warfarin was associated with worsening of HT (16.7% of patients) compared to antiplatelets (4.3%), but the outcome was still better than no medication. Nerological deterioration after HT was not associated with antithrombotic use. The frequency of stroke complications (e.g. neurological deterioration and death) at 1 month was significantly lower in patients treated with antithrombotics than those treated without.
The bottom line
In conclusion, the results of this study suggest that antithrombotics can safely be used after HT and may not be associated with HT worsening or neurological deterioration. These results suggest that there may be no firm basis for physicians to reject the use of antithrombotics after HT.
The fine print
Because this study is a retrospective study (analyzing patient records), further studies need to be carried out to clarify these results.
What’s next?
Ask your physician to discuss the risks and benefits of continuing antithrombotic use after HT detection in ischemic stroke.
Published By :
PLOS ONE
Date :
Feb 28, 2014
