Recurrent ischemic stroke associated with sildenafil and tadalafil use in a young adult

Stefanović-Budimkić, Maja; Jovanović, Dejana; Beslac-Bumbasirevic, Ljiljana; Ercegovac, Marko

doi:10.1016/j.clineuro.2011.11.003

Cited by 13 publications

(10 citation statements)

References 5 publications

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“…Second, the NO and cGMP pathway might be responsible for inhibition of platelet aggregation and activation. Finally, PDE5i are considered as an antithrombotic agent [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Scrotal hemorrhage after testicular sperm aspiration may be associated with phosphodiesterase-5 inhibitor administration: a retrospective study

et al. 2018

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BackgroundScrotal hemorrhage after testicular sperm aspiration (TESA) is uncommon in clinical operation. Phosphodiesterase-5 inhibitors (PDE5i) are commonly given to men who have difficulty providing a sperm sample for assisted reproductive technique such as in vitro fertilization. In this study, we examine the incidence of scrotal hemorrhage after TESA in men who received a PDE5i.MethodsIn this retrospective study, 504 men with TESA operation in Center for Reproductive Medicine, Nanfang Hospital, Southern Medical University were collected. Men in the drug group had taken orally PDE5i before TESA. Men in the control group only operated TESA. The testis volume, coagulation function were measured. Sonographic examination with Doppler imaging was performed when scrotal hemorrhage appeared.ResultsA total of 504 men with a mean age of 28.63 ± 4.22 years were included in the analysis. Of these, 428 did not receive a PDE5i prior to TESA and 76 received a PDE5i prior to TESA. Measures of coagulation function were not different between the groups. The incidence of hemorrhage was 0.0% in the control group and the drug group was 5.3%. The incidence of hemorrhage between two groups was different significantly (P = 0.000).ConclusionIn summary, the results of this study suggest that a PDE5i administration increases the risk of scrotal hemorrhage in men undergoing TESA, although the study design does not allow drawing a conclusion of cause and effect. Given the potential risk of scrotal hemorrhage after the ingestion of PDE5i, it may be wise not to administer it to men in whom a TESA may be performed.

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“…Second, the NO and cGMP pathway might be responsible for inhibition of platelet aggregation and activation. Finally, PDE5i are considered as an antithrombotic agent [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Scrotal hemorrhage after testicular sperm aspiration may be associated with phosphodiesterase-5 inhibitor administration: a retrospective study

et al. 2018

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“…However, tadalafil and sildenafil have been prescribed worldwide as treatments for erectile dysfunction. These medications have been suggested to be associated with rare but serious adverse events, such as ischemic stroke (4). One previous report described a case of pulmonary embolism after taking tadalafil in a patient with protein C deficiency (5).…”

Section: Discussionmentioning

confidence: 99%

The Development of Cerebral Venous Thrombosis after Tadalafil Ingestion in a Patient with Antiphospholipid Syndrome

Numata¹,

Shimoda²,

Shibata

et al. 2017

Intern. Med.

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We report a case of cerebral venous thrombosis related to the ingestion of tadalafil. A 45-year-old man presented with posterior headache and was diagnosed with tension headache. Five days later, he was transported to our hospital via ambulance due to a tonic-clonic seizure. Head MRI showed cerebral venous thrombosis (CVT). He confessed to having recently taken a large doses of tadalafil. His anti-cardiolipin antibody and anti-caldiolipin-β2-glycoprotein-I complex antibody levels were elevated. Our case suggests the possibility that tadalafil is related to both cardiovascular complications and CVT in patients with hypercoagulability. Patients with conditions associated with hypercoagulability, including antiphospholipid syndrome may be better advised to avoid the use of tadalafil.

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“…Although there have been several reports of ischemic stroke associated with sildenafil use [1][2][3][4] , this adverse effect is not widely appreciated, the drug is generally considered extremely safe [5][6][7] , and there have been no prior reports of aversion of threatened stroke with alteplace treatment. The underlying pathophysiologic mechanisms contributing to ischemic cerebral events have not been elucidated and have been postulated to reflect hypoperfusion distal to critical artery stenosis [8] , unrecognized transient arrhythmia [2,4] , cardioembolism or a hypercoagulable state [8][9][10] . None of these mechanisms appears to have been operative in the above case.…”

Section: Discussionmentioning

confidence: 99%

“…Although there have been several reports of ischemic stroke associated with sildenafil use [1][2][3][4] , this adverse effect is not widely…”

Section: Discussionmentioning

confidence: 99%

Sildenafil Associated Threatened Ischemic Stroke Reversed with Alteplase

Simons¹,

Rosengart²,

Schlick³

et al. 2017

IJNBD

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A 68-year-old male presented with a threatened ischemic stroke after ingesting sildenafil. Signs and symptoms promptly reversed with alteplase administration, and subsequent studies disclosed no other likely etiology for stroke. Although ischemic stroke owing to sildenafil has been reported, to our knowledge this is the first demonstration of reversal by alteplase. Case ReportA 68-year-old male with no prior history of hypertension, cardiac disease or stroke was transported to the emergency department after developing lower extremity weakness and slurred speech 30 minutes after ingesting of 40 mg of sildenafil. He was noted to be normotensive, in sinus rhythm, and to have dysarthria and a right facial droop, suggestive of left hemispheric ischemia. A non contrast CT scan of the head disclosed no evidence of hemorrhage, 6.7 mg of alteplace (TPA) was administered followed by infusion of 60.3 mg, during which all neurologic signs and symptoms abated, and he returned to his normal baseline. EKG showed normal sinus rhythm, CT angiogram of the head and neck, echocardiogram with bubble study, transcranial Doppler with micro-embolus detection and laboratory studies were all normal. His only risk factor for stroke was mild hyperlipidemia, controlled on 5 mg of rosuvastatin daily. There was no family history of stroke. DiscussionSildenafil is a competitive inhibitor of the cyclic guanosine monophosphate degrading enzyme phosphodiesterase type 5 and has been used for the treatment of both erectile dysfunction and pulmonary hypertension for approximately 15 years. Although there have been several reports of ischemic stroke associated with sildenafil use [1][2][3][4] , this adverse effect is not widelyCopyrights:

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Recurrent ischemic stroke associated with sildenafil and tadalafil use in a young adult

Cited by 13 publications

References 5 publications

Scrotal hemorrhage after testicular sperm aspiration may be associated with phosphodiesterase-5 inhibitor administration: a retrospective study

Scrotal hemorrhage after testicular sperm aspiration may be associated with phosphodiesterase-5 inhibitor administration: a retrospective study

The Development of Cerebral Venous Thrombosis after Tadalafil Ingestion in a Patient with Antiphospholipid Syndrome

Sildenafil Associated Threatened Ischemic Stroke Reversed with Alteplase

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