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28-04-2023 | Pituitary Adenoma

Antiplatelet and anticoagulation therapy and the risk of pituitary apoplexy in pituitary adenoma patients

Authors: Bronson Ciavarra, Timothy McIntyre, Matthew J. Kole, Wen Li, William Yao, Katie B. Guttenberg, Spiros L. Blackburn

Published in: Pituitary | Issue 4/2023

Abstract

Purpose

Pituitary apoplexy can be a life threatening and vision compromising event. Antiplatelet and anticoagulation use has been reported as a contributing factor in pituitary apoplexy (PA). Utilizing one of the largest cohorts in the literature, this study aims to determine the risk of PA in patients on antiplatelet/anticoagulation (AP/AC) therapy.

Methods

A single center, retrospective study was conducted on 342 pituitary adenoma patients, of which 77 patients presented with PA (23%). Several potential risk factors for PA were assessed, including: patient demographics, tumor characteristics, pre-operative hormone replacement, neurologic deficits, coagulation studies, platelet count, and AP/AC therapy.

Results

Comparing patients with and without apoplexy, there was no significant difference in the proportion of patients taking aspirin (45 no apoplexy vs. 10 apoplexy; p = 0.5), clopidogrel (10 no apoplexy vs. 4 apoplexy; p = 0.5), and anticoagulation (7 no apoplexy vs. 3 apoplexy; p = 0.7). However, male sex (p-value < 0.001) was a predictor for apoplexy while pre-operative hormone treatment was a protective factor from apoplexy (p-value < 0.001). A non-clinical difference in INR was also noted as a predictor for apoplexy (no apoplexy: 1.01 ± 0.09, apoplexy: 1.07 ± 0.15; p < 0.001).

Conclusions

Although pituitary tumors have a high risk for spontaneous hemorrhage, the use of aspirin is not a risk for hemorrhage. Our study did not find an increased risk of apoplexy with clopidogrel or anticoagulation, but further investigation is needed with a larger cohort. Confirming other reports, male sex is associated with an increased risk for PA.

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Title: Antiplatelet and anticoagulation therapy and the risk of pituitary apoplexy in pituitary adenoma patients
Authors: Bronson Ciavarra
Timothy McIntyre
Matthew J. Kole
Wen Li
William Yao
Katie B. Guttenberg
Spiros L. Blackburn
Publication date: 28-04-2023
Publisher: Springer US
Keywords: Pituitary Adenoma
Stroke
Anticoagulant
Pituitary Apoplexy
Published in: Pituitary / Issue 4/2023
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI: https://doi.org/10.1007/s11102-023-01316-5

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