In the cohort study adjusted hazard ratio for risk of subsequent intracranial haemorrhage or focal neurological deficit was 0.12, 95% CI 0.02–0.88; p=0.037 (one [2%] of 61 on antithrombotics vs. 29 [12%] of 239).
Cerebral cavernous malformations (CCMs) are small vascular lesions that are detected in up to 0·2% of the general population and can cause focal neurological deficits or seizures. According to a related commentary, clinicians typically avoid antithrombotics in these patients because these lesions are prone to bleeding, with an approximate risk of bleeding of 0·8–1·6% per year for asymptomatic lesions and 3.6–6.2% per year for symptomatic lesions, depending on location. It notes that avoiding antithrombotics is becoming increasingly difficult because of expanding indications for their use and an ageing population. Therefore the findings from this study provide some reassurance that clinicians can use antithrombotics safely, if clearly indicated, in patients with CCMs—particularly when the patient is asymptomatic and excision or radiosurgery is not indicated or not possible. It adds that a clinical trial of antithrombotics is well justified by the findings of this observational study, and hopefully will be done.