Medication intake and hemorrhage risk in patients with familial cerebral cavernous malformations

Abstract

OBJECTIVE The objective of this study was to analyze the impact of medication intake on hemorrhage risk in patients with familial cerebral cavernous malformation (FCCM). METHODS The authors’ institutional database was screened for patients with FCCM who had been admitted to their department between 2003 and 2020. Patients with a complete magnetic resonance imaging (MRI) data set, evidence of multiple CCMs, clinical baseline characteristics, and follow-up (FU) examination were included in the study. The authors assessed the influence of medication intake on first or recurrent intracerebral hemorrhage (ICH) using univariate and multivariate logistic regression adjusted for age and sex. The longitudinal cumulative 5-year risk of hemorrhage was calculated by applying Kaplan-Meier and Cox regression analyses adjusted for age and sex. RESULTS Two hundred five patients with FCCMs were included in the study. Multivariate Cox regression analysis revealed ICH as a predictor for recurrent hemorrhage during the 5-year FU. The authors also noted a tendency toward a decreased association with ICH during FU in patients on statin medication (HR 0.22, 95% CI 0.03–1.68, p = 0.143), although the relationship was not statistically significant. No bleeding events were observed in patients on antithrombotic therapy. Kaplan-Meier analysis and log-rank test showed a tendency toward a low risk of ICH during FU in patients on antithrombotic therapy (p = 0.085), as well as those on statin therapy (p = 0.193). The cumulative 5-year risk of bleeding was 22.82% (95% CI 17.33%–29.38%) for the entire cohort, 31.41% (95% CI 23.26%–40.83%) for patients with a history of ICH, 26.54% (95% CI 11.13%–49.7%) for individuals on beta-blocker medication, 6.25% (95% CI 0.33%–32.29%) for patients on statin medication, and 0% (95% CI 0%–30.13%) for patients on antithrombotic medication. CONCLUSIONS ICH at diagnosis was identified as a risk factor for recurrent hemorrhage. Although the relationships were not statistically significant, statin and antithrombotic medication tended to be associated with decreased bleeding events.

Immunothrombosis and vascular heterogeneity in cerebral cavernous malformation

“…41 Santos and colleagues also observed that patients on antithrombotic medication had fewer hemorrhagic events. 42 All of these studies support our findings and show that understanding the molecular signatures of coagulation in CCM could give insights regarding suitable antithrombotic pharmaceuticals for patients with CCM.…”

Prevalence, genetic and clinical characteristics in first-degree relatives of patients with familial cerebral cavernous malformations in China

“…13 16 27 Recent studies indicate that some medications can control the progression and reduce the burden of lesions in FCCM. [33][34][35][36] Thus, asymptomatic patients may benefit from FCCM drug therapy in the near future. Our study also identified ICH as the most common symptom in symptomatic patients with FCCMs.…”

Bleeding Risk of Cerebral Cavernous Malformations in Patients on Statin and Antiplatelet Medication: A Cohort Study

“…The rarity of hemorrhages during follow-up analysis in CCMs is a known limitation shared by other cohorts. 12,23 To overcome these limitations, prospective trials are needed, which are currently underway with the AT CASH EPOC trial, investigating the effect of atorvastatin on lesional iron deposition in CCMs. 24…”