A PREREQUISITE FOR ADDRESSING THE THERAPEUTIC DILEMMA OF CONTINUATION OF ANTIPLATELET THERAPY FOLLOWING AN INTRACRANIAL HEMORRHAGE? – A CASE STUDY REPORT

Krishnaja R. J., Lekshmi Johnson Maithyli and Dr. Babitha M.*

ABSTRACT

An intracranial hemorrhage is the bleed within the brain. Many patients with Intracranial hemorrhage may either suffer from history of ischemic events or ischemic pathologies which may frequently require antithrombotic therapy. This case study focuses on a patient with primary intracranial hemorrhage with a risk of thromboembolic pathology, demanding antiplatelet therapy, which is analysed here to illustrate the therapeutic dilemma of prescribing antiplatelets following the intracranial hemorrhage. At the time of admission , considering the severity of bleeding, antiplatelet medications which has been taken by the patient were withheld. Management is then mainly done according to standardized therapeutic management of Intracranial hemorrhage. Patient’s condition then improves and the patient is discharged without giving antipaltelets. But in this case, after 4 months the patient started showing thrombotic symptoms like dysarthria, weakness along with elevated blood pressure which increased the demand for antiplatelet therapy and started aspirin 75mg. After 7 weeks, the patients condition deteriorated and was readmitted with hemorrhagic stroke. This case study raises an important question regarding the continuation of an effective and safe antiplatelet medication in high thromboembolic risk patient who is in a post recovery period from an intra cerebral hemorrhage. In our case study we conclude that this particular dilemma requires a higher clinical research attention and a well designed randomized control trial which should be performed to make an authenticated advise to patients.

Keywords: Intracranial hemorrhage, antiplatelets, hemorrhagic stroke, thrombo embolic risk, therapeutic dilemma, case study.