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PurposePituitary apoplexy can be a life threatening and vision compromising event. Antiplatelet and anticoagulation use has been reported as a contributing factor in pituitary apoplexy (PA). Utilizing one of the largest cohorts in the literature, this study aims to determine the risk of PA in patients on antiplatelet/anticoagulation (AP/AC) therapy. MethodsA single center, retrospective study was conducted on 342 pituitary adenoma patients, of which 77 patients presented with PA (23%). Several potential risk factors for PA were assessed, including: patient demographics, tumor characteristics, pre-operative hormone replacement, neurologic de cits, coagulation studies, platelet count, and AP/AC therapy. ResultsComparing patients with and without apoplexy, there was no signi cant difference in the proportion of patients taking aspirin (45 no apoplexy vs. 10 apoplexy; p = 0.5), clopidogrel (10 no apoplexy vs. 4 apoplexy; p = 0.5), and anticoagulation (7 no apoplexy vs. 3 apoplexy; p = 0.7). However, male sex (pvalue < 0.001) was a predictor for apoplexy while pre-operative hormone treatment was a protective factor from apoplexy (p-value < 0.001). A non-clinical difference in INR was also noted as a predictor for apoplexy (no apoplexy: 1.01 ± 0.09, apoplexy: 1.07 ± 0.15; p < 0.001). ConclusionsAlthough pituitary tumors have a high risk for spontaneous hemorrhage, the use of aspirin is not a risk for hemorrhage. Our study did not nd an increased risk of apoplexy with clopidogrel or anticoagulation, but further investigation is needed with a larger cohort. Con rming other reports, male sex is associated with an increased risk for PA.

Purpose Pituitary apoplexy can be a life threatening and vision compromising event. Antiplatelet and anticoagulation use has been reported as a contributing factor in pituitary apoplexy (PA). Utilizing one of the largest cohorts in the literature, this study aims to determine the risk of PA in patients on antiplatelet/anticoagulation (AP/AC) therapy. Methods A single center, retrospective study was conducted on 342 pituitary adenoma patients, of which 77 patients presented with PA (23%). Several potential risk factors for PA were assessed, including: patient demographics, tumor characteristics, pre-operative hormone replacement, neurologic deficits, coagulation studies, platelet count, and AP/AC therapy. Results Comparing patients with and without apoplexy, there was no significant difference in the proportion of patients taking aspirin (45 no apoplexy vs. 10 apoplexy; p = 0.5), clopidogrel (10 no apoplexy vs. 4 apoplexy; p = 0.5), and anticoagulation (7 no apoplexy vs. 3 apoplexy; p = 0.7). However, male sex (p-value < 0.001) was a predictor for apoplexy while pre-operative hormone treatment was a protective factor from apoplexy (p-value < 0.001). A non-clinical difference in INR was also noted as a predictor for apoplexy (no apoplexy: 1.01 ± 0.09, apoplexy: 1.07 ± 0.15; p < 0.001). Conclusions Although pituitary tumors have a high risk for spontaneous hemorrhage, the use of aspirin is not a risk for hemorrhage. Our study did not find an increased risk of apoplexy with clopidogrel or anticoagulation, but further investigation is needed with a larger cohort. Confirming other reports, male sex is associated with an increased risk for PA.

Background and Objective: Right to left shunts (RLS) found with patent foramen ovale (PFO) are implicated in the pathogenesis of cryptogenic stroke and a risk factor for neurological event. The capability and sensitivity of Transcranial Doppler ultrasound (TCD) to detect a PFO has been established. However, predictors of false positive shunts detected by TCD and benefit of intracardiac echocardiogram (ICE) when studies show conflicting results have not been determined. Methods: In this retrospective study, patients who underwent shunt testing with ICE ± endovascular atrial septal defect closure from 2018 till 2022 were included. We abstracted data regarding the type of study used for shunt detection such as transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), ICE and TCD. PFO size and characteristics were evaluated. International consensus criteria were used for TCD PFO detection. Results: A total of 184 patients underwent ICE testing, of which 169 (93.4%) had prior TTE, 116 (63%) TEE, and 48 (25%) prior TCD. Among 48 patients with TCD, 24 had negative TTE and 4 had negative TEE. Mean (SD) age was 51.1(14.4). 110(59.8%) were female. Among all patient with ICE 169 (91.8%) had PFO. PFOs were detected in 38 out of 48 (79.1%) patients who had been assessed with both ICE and TCD, whereas 6 patients (12/5%) were found to have a RLS on TCD but no PFO on ICE, p<0.01. Comparing ICE and TCD grading scores for shunt detected, 45.2% had higher grade by TCD compared to ICE, p= 0.17. Among the six false positive cases on TCD, four of them had shower of microembolization and 2 of them had 0-10 HITS microemboli detection. Conclusion: Transcranial Doppler ultrasound detection of right to left shunt remains highly sensitive and a non-invasive tool. Considering ICE as gold standard, TCD is associated with false positive shunt detection. Further studies are warranted to assess the shunt characteristics on TCD that are associated with higher predictive value for identifying PFO.