A Novel Use of Direct Platelet Application During Surgery for Clopidogrel-Associated Intracerebral Hemorrhage

World Neurosurgery
Brendan D KilloryMartin Ollenschleger

Abstract

Dual antiplatelet therapy is associated with increased rates of intracerebral hemorrhage, especially in the context of subarachnoid hemorrhage. We present a case of a spontaneous hemorrhage in a patient treated with a Pipeline stent for a ruptured dissecting vertebrobasilar aneurysm and the novel use of direct application of platelets during surgery to control bleeding. A 54-year-old previously healthy woman presented with an intradural right vertebral artery dissection with a ruptured 6-mm pseudoaneurysm. The patient was started on aspirin and clopidogrel and the vessel was reconstructed with 2 Pipeline Embolization Devices. On postbleed day number 14, she became obtunded with a blown right pupil; computed tomography of the head demonstrated a large right temporal intracerebral hematoma. The patient was taken emergently to the operating room for evacuation of the clot. Intraoperatively, satisfactory control of bleeding was not achieved despite transfusing several units of platelets intravenously. Ultimately, a mixture of Floseal and platelets applied directly to the hematoma wall allowed prompt hemostasis. At 3 months the patient was doing extremely well clinically and angiography demonstrated occlusion of the aneurysm. This i...Continue Reading

References

Apr 2, 2009·The New England Journal of Medicine·Stuart J ConnollySalim Yusuf
May 12, 2009·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Claire J CreutzfeldtDavid L Tirschwell
Oct 17, 2009·Neurosurgery·Andrew M NaidechH Hunt Batjer
Nov 17, 2009·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·L DoradoA Dávalos
Jul 25, 2012·Stroke; a Journal of Cerebral Circulation·Santiago PalacioOscar R Benavente

❮ Previous
Next ❯

Citations

Dec 7, 2018·Neurology India·Shailendra RatreYad Ram Yadav
Nov 5, 2021·Neurosurgical Review·C SchonauerE Tessitore

❮ Previous
Next ❯

Related Concepts

Related Feeds

Aneurysm

Aneurysms are outward distensions or bulges that occurs in a weakened wall of blood vessels. Discover the latest research on aneurysms here.

Blood Clotting Disorders

Thrombophilia includes conditions with increased tendency for excessive blood clotting. Blood clotting occurs when the body has insufficient amounts of specialized proteins that make blood clot and stop bleeding. Here is the latest research on blood clotting disorders.