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Intracranial haemorrhage: 2 case reports In a retrospective observational single center study involving 7 patients, who were treated with aspirin and cangrelor between October 2017 and November 2018, 2 patients (a 41-year-old man and a 60-year-old woman) were described, who developed acute intracranial haemorrhage or minor intracranial haemorrhage during treatment with aspirin, cangrelor or ticagrelor [duration of treatments to reactions onsets not stated; not all routes and outcomes stated]. Patient 1:The man, who had intracranial ruptured aneurysm was admitted and planned for flow diverter stent placement. He received off-label antiplatelet therapy with IV cangrelor 30 µg/kg bolus 10 minutes before the stent positioning and IV bolus aspirin 250mg 30 minutes before the stent deployment. Then, he received IV cangrelor 4 µg/kg per minute infusion with an electric pump for 12 to 48 hour. After 1 day, the cangrelor therapy was switched to ticagrelor 90mg twice a day. However, he developed acute intracranial haemorrhage 12 hour after the endovascular procedure secondary to the use of ticagrelor. An MRI revealed haemorrhagic transformation of an acute ischaemic infarct. Subsequently, the therapy with ticagrelor was switched back to cangrelor. However, he experienced worsening of bleeding under cangrelor. Six days after the procedure, he died of an intracranial haemorrhage. Patient 3:The woman, who had intracranial unruptured aneurysm was admitted and planned for flow diverter stent placement. She received off-label antiplatelet therapy with IV cangrelor 30 µg/kg bolus 10 minutes before the stent positioning and IV bolus aspirin 250mg 30 minutes before the stent deployment. Then, she received IV cangrelor 4 µg/kg per minute infusion with an electric pump for 12 to 48 hours. On day 1, she developed a spontaneous and asymptomatic intraparenchymal haematoma [aetiology unknown]. On day 4, the cangrelor therapy was switched to ticagrelor 90mg twice a day and she was also commenced on IV aspirin 75 mg/day. However, she developed minor asymptomatic intracranial bleeding secondary to ticagrelor and aspirin. Hence, ticagrelor was discontinued and further treatment was started with cangrelor for 24 hours. Then, she restarted ticagrelor, and the cangrelor was discontinued 3 hours after the first dose of ticagrelor. Later, she was discharged without any complications. Abdennour L, et al. Preliminary Experience with Cangrelor for Endovascular Treatment of Challenging Intracranial Aneurysms. Clinical Neuroradiology 30: 453-461, No. 3, 803515260 Sep 2020. Available from: URL: http://doi.org/10.1007/s00062-019-00811-2

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