Asymptomatic microbleeds as a risk factor for aspirin-associated intracerebral hemorrhages

Abstract

The authors measured the presence and extent of asymptomatic microbleeds on gradient-recalled-echo MRI in 21 aspirin users who developed intracerebral hemorrhage and 21 aspirin users without history of intracerebral hemorrhage. Microbleeds were more frequent (19 vs 7, p < 0.001) and more extensive (mean number of microbleeds 13.3 vs 0.4, p < 0.001) in the intracerebral hemorrhage group than in the control group. Asymptomatic microbleeds may be a risk factor for aspirin-associated intracerebral hemorrhage.

Association between Cerebral Microbleeds on T2*-Weighted MR Images and Recurrent Hemorrhagic Stroke in Patients Treated with Warfarin following Ischemic Stroke

“…Although some studies have been performed to determine whether the use of antiplatelet therapy is associated with the occurrence of ICH in patients with microbleeds, 13 this is the first study aimed at determining whether the presence of microbleeds is associated with recurrent hemorrhagic stroke in patients who had undergone warfarin treatment following atrial fibrillation-associated cardioembolic infarction. Although it has been established that warfarin treatment is effective for preventing cerebral embolism arising from atrial fibrillation, the most serious adverse event in atrial fibrillation is hemorrhage complication.…”

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Although accumulating evidence suggests that the presence of microbleeds is a risk factor for ICH in patients treated by antiplatelet therapy 13,20 and hemorrhagic complications of anticoagulation in patients with prior ICH and atrial fibrillation have been reported, 21 little is known about the significance of microbleeds in anticoagulated patients because, to our knowledge, no studies have focused on the association between cerebral microbleeds and anticoagulation therapy in a large number of patients. On the other hand, previous studies focusing on radiographic characteristics have shown that the presence of microangiopathy (leukoaraiosis) detected by CT is a risk factor for warfarin-related ICH.…”

Silent cerebral microbleeds associated with arterial stiffness in an apparently healthy subject

“…The wide clinical availability of this equipment has attracted much interest in asymptomatic cerebral MBs, with findings to date showing a frequent occurrence in patients with stroke, particularly those with intracerebral hemorrhage; [2][3][4] higher prevalence in patients with recurrent intracerebral hemorrhage than in those with a first episode; [5][6][7] and that their presence predicts bleeding after thrombolytic therapy 8 and antiplatelet drug administration in ischemic stroke. 9 These findings have in turn raised concerns that MBs may be a marker for future symptomatic cerebral hemorrhage. Interestingly, although MBs are also observed in apparently healthy subjects, albeit at a far lower prevalence, [2][3][4] their pathological significance in these subjects remains to be determined.…”

Cerebral Microbleeds in Patients With Intracerebral Hemorrhage Are Associated With Previous Cerebrovascular Diseases and White Matter Hyperintensity, but Not With Regular Use of Antiplatelet Agents

“…Cerebral microbleeds are thought to be associated with the progression of small artery disease manifesting as bleeding and symptomatic intracerebral hemorrhage (ICH). 3,[7][8][9][10][13][14][15]18,[22][23][24]30,33) The prevalence of cerebral microbleeds in patients with ICH is thought to be around 60% in pooled analyses, which is higher than that in healthy adults (around 5%). 2,17) The presence of cerebral microbleeds appears to be linked to age, sex, history of cerebrovascular diseases, hypertension, diabetes mellitus, and use of antithrombotics.…”

“…12) Another study of patients treated with aspirin found the prevalence and number of cerebral microbleeds were much higher in patients with ICH (90%) than in those without ICH (33%). 33) On the other hand, the use of antiplatelet medication is apparently not associated with the presence of cerebral microbleeds. 2,3,20,28) Therefore, whether regular use of antiplatelets for patients with cerebral microbleeds can be recommended or not remains unclear.…”