Acute subdural hematoma caused by clopidrogel

Abstract

Clopidogrel, is a potent oral antiplatelet agent often used in the treatment of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. Clopidrogel a thienopyridine deritivate, selectively inhibits the binding to adenosine diphosphate, thereby inhibiting platelet aggregation. It thus reduces the formation of arterial and venous thrombi. Reported side effects of clopidrogel include gastrointestinal symptoms of nausea, stomach ache, diarrhea, and constipation. Serious side effects consist of an increased risk of bleeding, intracranial hemorrhage, and severe neutropenia. A 75-year-old man with syncope was admitted to cardiology clinic. The patient had undergone two vessel angioplasty 15 years earlier. Furthermore, the patient had undergone placement of coronary artery stent 3 months earlier. His daily prescription contained clopidrogel 75 mg for the past 3 years. Fourteen hours after admittance to the cardiology clinic, the patient experienced a blackout. A computed tomography of the brain revealed acute subdural hematoma of the right frontoparietal region with 1.5 cm midline shift. The patient subsequently underwent right frontoparietal craniotomy with drainage of the subdural hematoma. Unfortunately, the patient died on the postoperative eleventh day.