BMJ  2005;331:439-442 (20 August), doi:10.1136/bmj.331.7514.439

Clinical review

Evidence based case report

Should a patient with primary intracerebral haemorrhage receive antiplatelet or anticoagulant therapy?

¹ Department of Stroke Medicine, Morriston Hospital, Morriston, Swansea SA6 6NL

The first 150 words of the full text of this article appear below.

Introduction

Patients with primary intracranial haemorrhage may have risk factors for future thromboembolic events. Such a situation presents a therapeutic dilemma, as illustrated by the following case. A 55 year old man was admitted with right sided weakness. His history included hypertension that was difficult to control, type 2 diabetes, angina, and hyperlipidaemia. He had also had a minor stroke affecting his right side about 10 years previously. He was taking medication: aspirin 75 mg, atorvastatin 10 mg, bendroflumethiazide 2.5 mg, ramipril 2.5 mg, amlodipine 5 mg, isosorbide mononitrate modified release 60 mg, pioglitazone 15 mg (all once a day); hydralazine 50 mg twice a day; and metformin 850 mg and methyldopa 250 mg three times a day. He had smoked 20-30 cigarettes a day most of his adult life until 10 yeas previously, and he drank alcohol in moderation.

Examination confirmed grade 4/5 weakness of his right arm and leg . . . [Full text of this article]

Should he resume his antiplatelet therapy?

Search strategy and results
What other measures reduce risk of stroke in such patients?
Case progression

Should anticoagulation be used?

Search strategy and results
Measures for minimising risk of haemorrhage

When is best time to start antithrombotic therapy?

Search and results
Outcome

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Rapid Responses:

Read all Rapid Responses

Indeed it's a hard nut to crack!!

Dr Fatai Kunle Salawu,FMCP,FWACP
bmj.com, 19 Aug 2005 [Full text]

No universal rule

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bmj.com, 20 Aug 2005 [Full text]

Primary intracerebral haemorrhage or haemorrhagic transformation of an ischaemic infarct?

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Author's reply

Mushtaq Wani
bmj.com, 12 Sep 2005 [Full text]

RE: Should a patient with primary intracerebral haemorrhage receive

David M Wilson, et al.
bmj.com, 5 Oct 2005 [Full text]

Re: Primary intracerebral haemorrhage or haemorrhagic transformation of an ischaemic infarct?

Mushtaq Wani
bmj.com, 10 Oct 2005 [Full text]

Re: RE: Should a patient with primary intracerebral haemorrhage receive

Mushtaq Wani
bmj.com, 17 Oct 2005 [Full text]