Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo 113-8519, Japan.
Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo 113-8519, Japan.
J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105216. doi: 10.1016/j.jstrokecerebrovasdis.2020.105216. Epub 2020 Aug 12.
Convexity subarachnoid hemorrhage (cSAH) is typically due to head trauma, but it rarely occurs subsequent to acute ischemic stroke. Direct oral anticoagulants (DOACs) have favorable bleeding profiles as compared with warfarin, and, to our knowledge, no DOAC has been regarded as a causative agent for cSAH. Here, we reported 2 patients with cSAH apparently caused by starting DOAC therapy. No hemorrhage had been evident just prior to treatment initiation, but cSAH occurred so soon after DOAC therapy began. Each of our patients had occlusion or severe stenosis of a major artery due to emboligenic disease, and cSAH occurred in the territory of the affected artery. Reperfusion and dynamic changes in perfusion pressure due may trigger cSAH. Clinicians should remain alert for cSAH when starting DOAC for treatment of embolic ischemic stroke during the acute phase.
凸面蛛网膜下腔出血（cSAH）通常是由于头部外伤引起的，但很少发生在急性缺血性中风之后。与华法林相比，直接口服抗凝剂（DOAC）具有更好的出血风险特征，据我们所知，还没有一种 DOAC 被认为是 cSAH 的致病因素。在这里，我们报告了 2 例明显由开始 DOAC 治疗引起的 cSAH 患者。在开始治疗之前，没有明显的出血，但在开始 DOAC 治疗后不久就发生了 cSAH。我们的每个患者都有由于栓塞性疾病导致的主要动脉闭塞或严重狭窄，cSAH 发生在受影响动脉的区域。再灌注和灌注压力的动态变化可能会引发 cSAH。当在急性期开始使用 DOAC 治疗栓塞性缺血性中风时，临床医生应警惕 cSAH 的发生。
