Microbleed prevalence and burden in anticoagulant‐associated intracerebral bleed

Lioutas, Vasileios‐Arsenios; Goyal, Nitin; Katsanos, Aristeidis H.; Krogias, Christos; Zand, Ramin; Sharma, Vijay K.; Varelas, Panayiotis N.; Malhotra, Konark; Paciaroni, Maurizio; Sharaf, Aboubakar; Chang, Jason J.; Kargiotis, Odysseas; Pandhi, Abhi; Schroeder, Christoph; Tsantes, Argyrios; Boviatsis, Efstathios; Mehta, Chandan; Mitsias, Panayiotis; Selim, Magdy; Alexandrov, Andrei V.; Tsivgoulis, Georgios

doi:10.1002/acn3.50834

Cited by 16 publications

(7 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After obtaining the full texts of potentially eligible for inclusion studies we excluded 3 studies not providing outcomes of interest and/or reporting overlapping data with other publications (Table 1) [12][13][14], leaving a total of 7 eligible studies (2 RCTs, 1 prospective cohort study and 4 retrospective cohort studies) including a total of 3734 participants (Table 2) [15][16][17][18][19][20][21]. Three of the studies included 849 patients with history of ischemic stroke (IS) or transient ischemic attack (TIA) [15,17,19,21], 79 of whom had evidence of confluent white matter hyperintensities on baseline neuroimaging [21]. Two of the studies included 252 patients with spontaneous ICH [17,18], 89 of whom had history of pretreatment with oral anticoagulants [18].…”

Section: Resultsmentioning

confidence: 99%

Statin treatment and cerebral microbleeds: A systematic review and meta-analysis

Katsanos

Lioutas

Charidimou

et al. 2021

Journal of the Neurological Sciences

Self Cite

View full text Add to dashboard Cite

Although statins have been associated with increased risk of spontaneous intracerebral hemorrhage, their relationship with cerebral microbleeds (CMBs) formation is poorly understood. We systematically reviewed previously published studies reporting on the association between CMBs presence and current statin use.We performed a systematic search in MEDLINE and SCOPUS databases on October 24, 2019 to identify all cohorts from randomized-controlled clinical trials or observational studies reporting on CMB prevalence and statin use. We extracted cross-sectional data on CMBs presence, as provided by each study, in association to the history of current statin use. Random effects model was used to calculate the pooled estimates. We included 7 studies (n = 3734 participants): unselected general population [n = 1965], ischemic stroke [n = 849], hemorrhagic stroke [n = 252] and patients with hypertension over the age of 60 [n = 668]. Statin use was not associated with CMBs presence in either unadjusted (OR = 1.15, 95%CI: 0.76-1.74) or adjusted analyses (OR = 1.09, 95%CI: 0.64-1.86). Statin use was more strongly related to lobar CMB presence (OR = 2.01, 95%CI: 1.48-2.72) in unadjusted analysis. The effect size of this association was consistent, but no longer statistically significant in adjusted analysis that was confined to two eligible studies (OR = 2.26, 95%CI: 0.86-5.91). Except for the analysis on the unadjusted probability of lobar CMBs presence, considerable heterogeneity was present in all other analyses (I 2 > 60%). Our findings suggest that statin treatment seems not to be associated with CMBs overall, but may increase the risk of lobar CMB formation. This hypothesis deserves further investigation within magnetic resonance imaging ancillary studies of randomized trials.

show abstract

Section: Resultsmentioning

confidence: 99%

Statin treatment and cerebral microbleeds: A systematic review and meta-analysis

Katsanos

Lioutas

Charidimou

et al. 2021

Journal of the Neurological Sciences

Self Cite

View full text Add to dashboard Cite

show abstract

“…124 Similarly, statin pretreatment was not associated with CMB presence among patients who had an acute cardioembolic stroke who were anticoagulation-naïve. 125 Finally, there are conflicting data regarding the potential association of statin pretreatment with CMB presence or burden in patients with acute ICH (spontaneous 126 or anticoagulation-associated 127 ). In view of the former associations, CMB presence or high burden on brain MRI should not be used to withhold statin therapy for otherwise eligible patients in the settings of primary and secondary stroke prevention.…”

Section: Lipid-lowering Therapies and Cmbsmentioning

confidence: 99%

Cerebral microbleeds: from depiction to interpretation

Puy

Pasi

Rodrigues

et al. 2021

J Neurol Neurosurg Psychiatry

Self Cite

View full text Add to dashboard Cite

Cerebral microbleeds (CMBs) are defined as hypointense foci visible on T2*-weighted and susceptible-weighted MRI sequences. CMBs are increasingly recognised with the widespread use of MRI in healthy individuals as well as in the context of cerebrovascular disease or dementia. They can also be encountered in major critical medical conditions such as in patients requiring extracorporeal mechanical oxygenation. The advent of MRI-guided postmortem neuropathological examinations confirmed that, in the context of cerebrovascular disease, the vast majority of CMBs correspond to recent or old microhaemorrhages. Detection of CMBs is highly influenced by MRI parameters, in particular field strength, postprocessing methods used to enhance T2* contrast and three dimensional sequences. Despite recent progress, harmonising imaging parameters across research studies remains necessary to improve cross-study comparisons. CMBs are helpful markers to identify the nature and the severity of the underlying chronic small vessel disease. In daily clinical practice, presence and numbers of CMBs often trigger uncertainty for clinicians especially when antithrombotic treatments and acute reperfusion therapies are discussed. In the present review, we discuss those clinical dilemmas and address the value of CMBs as diagnostic and prognostic markers for future vascular events.

show abstract

“…In the study group, CMB prevalence was 51% (52% in VKA, 48% in NOAC). NOAC patients had a lower CMB count, and ≥ 5 CMBs were less prevalent in the NOAC group [90].…”

Section: Oral Anticoagulantsmentioning

confidence: 87%

Cerebral microbleeds in neurological practice: concepts, diagnostics and clinical aspects

Wach-Klink

Iżycka‐Świeszewska

Kozera

et al. 2021

Neurol Neurochir Pol.

View full text Add to dashboard Cite

Introduction: Due to the widespread use of magnetic resonance imaging (MRI) in neurological diagnostics, the number of patients detected as having cerebral microbleeds (CMBs) continues to increase. However, their clinical impact still remains controversial, especially the question of whether CMBs significantly increase the risk of life-threatening intracerebral haemorrhage (ICH) in patients undergoing intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT), or in patients on anticoagulant therapy or statins. State of the art:The term 'CMB' is a radiological concept that aims to illustrate microscopic pathology of perivascular hemosiderin deposits corresponding most probably to small foci of past bleeding. MRI images in sequence T2*-GRE and susceptibility-weighted imaging (SWI) are used for a diagnosis of a CMB. This review summarises the current knowledge regarding the definition, prevalence, genetics, risk factors, radiological diagnosis and differential diagnosis of a CMB. We discuss its role as an indicator of future ischaemic or haemorrhagic events in high risk patients or those on antiplatelet or anticoagulant therapy, and its prognostic value for reperfusion strategies and for the development of dementia. Future direction: The place of CMBs in current guidelines is explored herein. It must be emphasised that the recommendations relating to CMBs are expert opinions. Therefore, at the end of this review, we pose a number of questions that future clinical trials should answer.

show abstract

Microbleed prevalence and burden in anticoagulant‐associated intracerebral bleed

Cited by 16 publications

References 17 publications

Statin treatment and cerebral microbleeds: A systematic review and meta-analysis

Statin treatment and cerebral microbleeds: A systematic review and meta-analysis

Cerebral microbleeds: from depiction to interpretation

Cerebral microbleeds in neurological practice: concepts, diagnostics and clinical aspects

Contact Info

Product

Resources

About