ABSTRACT
Like all antithrombotic drugs, antiplatelet agents expose to a risk of bleeding complications. Clinical research has extensively focused on the efficacy of these drugs to reduce ischemic events. The bleeding risk associated with them was solely considered as an inevitable and acceptable complication. When two new potent P2Y12-receptor inhibitors, prasugrel and ticagrelor, were marketed, the risk of major bleeding increased. These new agents have modified the balance between the absolute risk reduction in ischemic events and the absolute risk increase in bleeding events. This paper is an update on the bleeding risk assessment associated with antiplatelet agents. It discusses the place of platelet function monitoring, and the optimal management of bleeding complications. It addresses the challenging issue of reversal of antiplatelet therapy, focusing especially on ticagrelor, which pharmacodynamics complicate bleeding management.
Subject(s)
Drug-Related Side Effects and Adverse Reactions/therapy , Hemorrhage/chemically induced , Hemorrhage/therapy , Platelet Aggregation Inhibitors/therapeutic use , Adenosine/administration & dosage , Adenosine/adverse effects , Adenosine/analogs & derivatives , Aspirin/administration & dosage , Aspirin/adverse effects , Clopidogrel , Drug-Related Side Effects and Adverse Reactions/prevention & control , Humans , Platelet Aggregation Inhibitors/adverse effects , Risk Factors , Ticagrelor , Ticlopidine/administration & dosage , Ticlopidine/adverse effects , Ticlopidine/analogs & derivativesABSTRACT
The early use of continuous positive airway pressure ventilation has been shown to be effective and is recommended for patients with obstructive sleep apnea. The complications of continuous positive airway pressure ventilation are not well described. We report two cases of pneumocephalus following the use of continuous positive airway pressure ventilation after transsphenoidal surgery. One patient had an obstructive sleep apnea and the other suffered acute respiratory failure. In both cases, pneumocephalus caused major morbidity and required specific treatment and prolonged considerably hospital stay. Based on these observations we believe new precautions in the use of noninvasive continuous positive airway pressure ventilation should be recommended.