Key result
Aspirin and ticagrelor DAPT linked to acute spontaneous subdural hematoma in an ESRD patient.
Why the study?
Acute spontaneous subdural hematomas are relatively rare bleeding complications of dual antiplatelet therapy, but the risk of intracranial hemorrhage is higher with reduced eGFR and liver disease.
Case Report (n=1)
This case highlights the rare but severe risk of acute spontaneous subdural hematoma following DAPT initiation in high-risk patients with end-stage renal disease and liver disease.
Rare spontaneous subdural hematoma may occur on DAPT; this case report leaves open surveillance needs and causality.
Dual antiplatelet therapy (DAPT) has been widely utilized for secondary prevention in patients with cardiovascular diseases, such as post-drug eluting stent insertion, stroke, and peripheral vascular disease. The occurrence of bleeding complications, including intracranial hemorrhage, has been extensively studied in relation to DAPT. However, the occurrence of acute spontaneous subdural hematomas in this context is relatively rare. These hematomas can manifest through various symptoms, including altered mental status (AMS) and confusion. The risk of intracranial hemorrhage is particularly higher in patients receiving aspirin with ticagrelor, especially in those with reduced estimated glomerular filtration rate (eGFR) and liver disease. In this case report, we present the case of a patient with end-stage renal disease undergoing peritoneal hemodialysis and a remote history of liver transplant. The patient presented to the hospital with chest pain, subsequently underwent drug-eluting stent placement, and was initiated on DAPT. Following the initiation of DAPT, the patient developed confusion and was diagnosed with an acute spontaneous subdural hematoma. The patient underwent middle meningeal artery embolization to manage the hematoma.
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Mousa et al. (2023) conducted a case report in Acute Spontaneous Subdural Hematoma (n=1). Dual antiplatelet therapy (aspirin and ticagrelor) was evaluated on Development of acute spontaneous subdural hematoma. A 64-year-old male with end-stage renal disease developed an acute spontaneous subdural hematoma shortly after starting dual antiplatelet therapy with aspirin and ticagrelor.
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