2083 Antiplatelet, Anticoagulants, Non-steroidal Anti-inflammatory Drugs (NSAIDs) and Hemorrhagic Risk in Adult Patients With Brain Arteriovenous Malformations (bAVMs)

INTRODUCTION: Compared to hypertensive intracranial hemorrhage (ICH), use of antithrombotic agents in bAVM patients is rare due to younger age. Due to the scarcity of data, the risk associated with antiplatelet, anticoagulants, and NSAID use in bAVM rupture is unclear. METHODS: Adult (>18 years), non-HHT patients with a single bAVM were included. Patients with incomplete data were excluded. Primary outcome was hemorrhagic presentation. Regular NSAID use was defined as medical condition that is associated with prescription of NSAIDS, such as osteoarthritis or back pain. Antiplatelet and anticoagulant use was listed individually based on the agent and dosage, except for multiple agents which were all categorized as “multiple”. We included all variables of R2eDAVM score. Univariable analysis was performed using logistic regression, and variables with p<0.01 were included in a multivariable logistic regression model. RESULTS: A total of 801 patients were enrolled in this study. Mean age was 42.6 years, with 46.6% being male. 295 patients had hemorrhagic presentation (36.8%). 105 patients (13.1%) had antiplatelet use, and 9 patients(1.1%) had anticoagulant use, with both being non-significant. Fifty-one (6.4%) patients had regular NSAIDs use, with more having hemorrhagic presentation (10.5% vs. 4.0%, p<0.001). Most common reasons for NSAIDs were back pain (n=13, 25.4%), osteoarthritis (n=11, n=21.6%) and migraine (n=8, 15.7%). All variables from R2eDAVM significant in univariable analysis. In multivariable analysis, all variables from R2eDAVM except for exclusive deep venous drainage (p=0.085) were significantly associated with hemorrhagic presentation. Regular NSAID use was strongly associated with hemorrhagic presentation (OR = 2.73, CI: [1.48, 5.14], 0 = 0.001). CONCLUSIONS: We did not appreciate increased hemorrhagic risk with antiplatelet and anticoagulant use. However, regular use of NSAIDs was associated with almost a 3-fold risk of hemorrhagic presentation in bAVMs patients. Further studies are needed to affirm this finding.