Antiplatelet Therapy, Cerebral Microbleeds, and Intracerebral Hemorrhage

Qiu, Jianting; Ye, Huirong; Wang, Jialiang; Yan, Jiangzhi; Wang, Jian; Wang, Yujie

doi:10.1161/strokeaha.118.021789

Cited by 38 publications

(33 citation statements)

References 9 publications

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“…Our study showed that antiplatelet use was associated with presence of CMBs in ischemic stroke patients with AF/RHD. Although controversies existed in the literature (14, 26–28), our finding is consistent with three recent meta-analyses, which all showed similar associations in patients with ischemic stroke or TIA (15, 29, 30). Some of the previous studies suggested that different type of antiplatelets may have different effects on development of CMBs.…”

Section: Discussionsupporting

confidence: 92%

“…Prior use of antiplatelets and especially aspirin were only significantly associated with occurrence of strictly lobar CMBs rather than deep or infratentorial CMBs. Our findings are in line with the Rotterdam Scan Study (31) and the newly published meta-analysis (30). This result may be explained by the different underlying pathophysiologic mechanisms of CMBs in different locations.…”

Section: Discussionsupporting

confidence: 91%

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Prior Antithrombotic Therapy Is Associated With Cerebral Microbleeds in Ischemic Stroke Patients With Atrial Fibrillation and/or Rheumatic Heart Disease

et al. 2019

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Background and purpose: Cerebral microbleeds (CMBs) could contribute to an increased risk of intracerebral hemorrhage in patients with antithrombotic therapy (antiplatelets or anticoagulants). Antithrombotic agents are commonly prescribed to the patients with atrial fibrillation (AF) and/or rheumatic heart disease (RHD) for preventing ischemic stroke. However, the impact of antithrombotic therapy on CMBs remained controversial. We aimed to explore the association between the prevalence of CMBs and prior antithrombotic therapy in ischemic stroke patients with AF and/or RHD.Materials and Methods: Ischemic stroke patients with AF and/or RHD within 7 days of onset from two hospitals were enrolled. Clinical information, prior use of antiplatelets or anticoagulation, presence and location of CMBs on susceptibility weighted imaging were recorded. We investigated the association of antithrombotic use with the presence or location of CMBs using multivariable logistic regression.Results: A total of 160 patients (68 males; median age, 71 years) were included. CMBs were observed in 90 (56.3%) patients, of whom 37 were with strictly lobar CMBs and 53 were with deep or infratentorial CMBs. There was a significant difference in antiplatelet use between patients with and without CMBs (33.3 vs. 11.4%, P = 0.001), but not found in anticoagulants. Prior use of antiplatelets was independently associated with the presence of CMBs (OR 3.075, 95% CI 1.175–8.045, P = 0.022) and especially strictly lobar CMBs (OR 2.635, 95% CI 1.050–6.612, P = 0.039) in multivariate analysis.Conclusions: The present study suggests that CMBs are common in ischemic stroke patients with AF and/or RHD and prior antiplatelet use may relate to the presence of CMBs predominantly in the strictly lobar region. Whether anticoagulants could cause CMBs need to be determined in future longitudinal studies.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

Prior Antithrombotic Therapy Is Associated With Cerebral Microbleeds in Ischemic Stroke Patients With Atrial Fibrillation and/or Rheumatic Heart Disease

et al. 2019

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“…[1][2][3] Some brain imaging features of intracerebral haem orrhage and cerebral small vessel diseases are associ ated with a higher risk of intracerebral haemorrhage recurrence in general, and in people taking antiplatelet therapy. [4][5][6][7][8] For example, the proportional increase in the risk of intracerebral haemorrhage recurrence is up to five times higher after lobar versus nonlobar haemorrhage, 8 up to sixtimes higher with presence versus absence of cerebral microbleeds on MRI, 7 and roughly fourtimes higher with presence versus absence of superficial siderosis on MRI. 6 Consequently, guidelines and opin ions suggest that location of intracerebral haemorrhage and some features of cerebral small vessel diseases can guide therapeutic decisions.…”

Section: Introductionmentioning

confidence: 99%

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Salman¹,

Mitra²,

Rodrigues³

et al. 2019

The Lancet Neurology

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Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy. Methods RESTART was a prospective, randomised, open-label, blinded-endpoint, parallel-group trial at 122 hospitals in the UK that assessed whether starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. For this prespecified subgroup analysis, consultant neuroradiologists masked to treatment allocation reviewed brain CT or MRI scans performed before randomisation to confirm participant eligibility and rate features of the intracerebral haemorrhage and surrounding brain. We followed participants for primary (recurrent symptomatic intracerebral haemorrhage) and secondary (ischaemic stroke) outcomes for up to 5 years (reported elsewhere). For this report, we analysed eligible participants with intracerebral haemorrhage according to their treatment allocation in primary subgroup analyses of cerebral microbleeds on MRI and in exploratory subgroup analyses of other features on CT or MRI. The trial is registered with the ISRCTN registry, number ISRCTN71907627.

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“…A meta-analysis on the relationship between antiplatelet therapy and CMBs found that antiplatelet therapy was significantly associated with presence of CMBs in patients with stroke but not in stroke-free individuals [29]. A more recent meta-analysis [30] that included 37 studies did not just clarify the increased risk of CMBs on antiplatelet therapy; moreover, they related their use to the association with strictly lobar microbleeds rather than deep/infratentorial microbleeds.…”

Section: Discussionmentioning

confidence: 99%

Do cerebral microbleeds affect cognition in patients with symptomatic small vessel disease?

Abdullah

Zakieldin

Bayomy

et al. 2020

Egypt J Neurol Psychiatry Neurosurg

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Background: Dementia and cognitive impairment are becoming increasingly a major health problem, pronounced by increased life expectancy. Cerebral small vessel disease (cSVD) is among the major causes of cognitive deterioration, yet cerebral microbleeds (CMBs) which are a common association of cSVD are still not sure to be related to cognition. Aim of the study: The study aims to determine whether the number and localization of CMBs correlate with cognition in patients with symptomatic small vessel disease (SVD), according to Montreal Cognitive Assessment (MoCA) test. Subjects and methods: This cross-sectional study included 85 Egyptian patients with symptomatic SVD, from the neuropsychiatry clinic of the Main Suez Hospital in Suez City, in the period between February 2017 and February 2018. Subjects were classified according to CMB presence into CMB-positive and CMB-negative groups. Both groups are assessed using MRI imaging and MoCA test for cognitive function. Results: In our study, CMBs recorded a high prevalence rate of SVD patients. Subjects with MBs were mainly males and significantly older, with higher white matter lesion volume and more lacunar infarcts. MoCA test detected significant impairment in visuospatial/executive function, attention, and total scores in CMB-positive group. Both frontal and parietal MBs showed independent association with visuospatial/executive impairment. Deep MBs in the basal ganglia were proved to be independent risk factor for attention affection. Conclusion: Number and localization of MBs proved to be important in determining cognitive consequences. The relations with cognitive performance were mainly driven by frontal, parietal, and deep located MBs in the basal ganglia. Memory affection in frontal MBs was dependent to severe white matter intensities and lacunes.

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Antiplatelet Therapy, Cerebral Microbleeds, and Intracerebral Hemorrhage

Abstract: Antiplatelet drug use was associated with increased risk of strictly lobar MBs and increased the intracerebral hemorrhage incidence in participants with CMBs.

Cited by 38 publications

References 9 publications

Prior Antithrombotic Therapy Is Associated With Cerebral Microbleeds in Ischemic Stroke Patients With Atrial Fibrillation and/or Rheumatic Heart Disease

Prior Antithrombotic Therapy Is Associated With Cerebral Microbleeds in Ischemic Stroke Patients With Atrial Fibrillation and/or Rheumatic Heart Disease

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Do cerebral microbleeds affect cognition in patients with symptomatic small vessel disease?

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