Hi, I could not find any reliable articles about the patients with intracranial traumatic contusion bleeding, with traumatic SAH or subdural hematoma. Cardiologists are pretty strict about giving ASS, Clopidogrel and Heparin despitr the bleeding in the head. Do you guys have some ideas how to achieve a maximal compromise on both sides (neurosurgery and cardiology?
Dear Mr. Pavlov,
this is a daily dilemma.
The coronary stents are just inserted but in my opion the bleeding in the head is the crucial factor. So monitor the SAH via CCT-Scans and try to avoid any ASS, Clopidogrel and Heparin in the first days. If the bleed is stable, than start with one ASS or Clopidogrel with low-dose Heparin.
You have to continue Clipidogrel, and pause ASA. I do not see the reason to give Heparin with DAPT after PCI. If you don't give Clipidogrel, you will have a patent with STEMI along with SAH, and studies have shown that mostly major bleeding with DAPT are from ASA and multiple studies are prooving benefit with Clipidogrel and ASA for 7 days, and than only Clipidogrel. So.. To be short, in no circumstances you can not "pause" Clipidogrel, but ASA you can, and Heparin has no benefit after PCI.
Best regards
The constellation is relatively common in multifocal vascular diseases. Like as for every endovascular surgery, the most essential presurgical tests must include at least standard techniques exploring the brain vascular system. It is indispensable to calculate the risk/profit ration in every individual patient in term of existing general vascular pathology.@
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