Ventriculostomy associated haemorrhage: A complication of anti-platelet therapy during coiling

Abstract

A young man with Fisher grade IV subarachnoid haemorrhage (SAH) underwent aneurysm coiling following external ventriculostomy. Coiling was complicated by thrombus formation and parent vessel occlusion necessitating anti-platelet therapy. Several hours after anti-platelet therapy, catastrophic haemorrhage associated with the ventriculostomy tract occurred. Timing and location of haemorrhage suggest combined anti-platelet therapy and ventriculostomy may have been causal. The literature on ventriculostomy haemorrhage rates and risks with concomitant anti-platelet therapy are reviewed. Where endovascular coiling is being considered, the possibility of ventriculostomy-related haemorrhage should be considered and should influence subsequent treatment decisions.

Keywords::

• anticoagulation
• aneurysmal SAH
• coiling
• CSF shunt complication
• external ventricular drain
• subdural haematoma
• ventriculostomy associated haemorrhage

Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.