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Columbia Neurosurgeons Team Up to Investigate the Effect of Antiplatelet Drugs on Subarachnoid Hemorrhage

image-of-pills-medication antiplateletAnyone who has watched even one game of football knows that the quarterback doesn’t do his job alone. He gets a lot of help from those who guard him and ward off opposing players out to get him.

Similarly, in medicine, a physician treating a medical problem is frequently supported by a team of specialists.

At the helm is the physician “quarterback” treating the patient’s primary problem. And just like in football, a solution to one problem can sometimes lead to complications elsewhere, requiring help from another member of the team.

When this happens in medicine, the expertise of a specialist in another field is often needed. Neurosurgeons, for example, get called in whenever a treatment causes bleeding into the brain. In particular, this can happen with a class of drugs called antiplatelet medications.

Physicians from the Department of Neurosurgery here at Columbia University Medical Center/NewYork-Presbyterian Hospital, including Drs. Sean D. Lavine, Philip M. Meyers and E. Sander Connolly, together with recent Columbia graduate Dr. David P. Bray and former neurosurgery resident Dr. Jason A. Ellis, recently took a closer look at possible negative effects on the brain associated with antiplatelet medicine.

Antiplatelet medications have long been used with great success by cardiologists to treat diseases of the heart and blood vessels. These drugs have been life savers in terms of preventing future heart attacks and strokes.

Unfortunately for some, however, past research has also found that patients on antiplatelet medicine are at risk for a type of bleeding into the brain known as a subarachnoid hemorrhage. The word “subarachnoid” refers to the location of the hemorrhage (bleed), just under the outer surface of the brain.

These bleeds are often angiogram-negative. This means they are not visible on the most commonly used test for this problem—an angiogram. For most types of subarachnoid hemorrhage, an angiogram will show that the bleeding arises from an abnormal blood vessel. However, in angiogram-negative subarachnoid hemorrhage, the blood vessels appear normal.

Cases of angiogram-negative subarachnoid hemorrhage seem to be on the rise too, possibly due to the increased use of antiplatelet medicine. Another significant finding is that people on antiplatelet drugs who do suffer subarachnoid hemorrhage tend to have worse outcomes than those not on these medications.

With their recent research, the Columbia team set out to discover why patients on antiplatelet medicine might do worse. They looked at 108 patients diagnosed with an angiogram-negative subarachnoid hemorrhage. Some were on antiplatelet medicine; some were not. All had also received CT scans when admitted to the hospital for their illness.

Using the information provided from the CT scans, the researchers were able to calculate the amount, or volume, of blood present in the hemorrhage. They found that patients on antiplatelet medicine had significantly more blood in their brain bleed than those not on that type of medicine. There was also some evidence that those who took the medicine bled further into the brain, into deep spaces called ventricles.

The authors published their results recently in World Neurosurgery. While they say there is still a lot more research to be done, knowing more about why and how this problem occurs is the first line of defense.

Learn more about Dr. Lavine on his bio page here.
Learn more about Dr. Meyers on his bio page here.
Learn more about Dr. Connolly on his bio page here.

Image credit: ©stevepb/pixabay

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