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Risk vs benefit of anti-thrombotic therapy in ischaemic stroke patients with cerebral microbleeds

Yannie O Y Soo1, Song Ran Yang, Wynnie W M Lam

  • 1Division of Neurology, Dept. of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong.

Journal of Neurology
|January 22, 2009
PubMed
Abstract

Insights

Cerebral microbleeds (MB) increase the risk of intracerebral haemorrhage (ICH) in ischemic stroke patients. While anti-thrombotic agents are generally beneficial, those with numerous MBs may face higher ICH risks than treatment benefits.

Area of Science:

  • Neurology
  • Radiology
  • Cardiovascular Research

Background:

  • Retrospective studies link cerebral microbleeds (MB) on MRI to increased intracerebral haemorrhage (ICH) risk.
  • Ischemic stroke patients with MB may face competing risks from anti-thrombotic therapy.

Purpose of the Study:

  • To prospectively evaluate the risk of ICH in ischemic stroke patients with varying quantities of MB.
  • To compare the benefits of anti-thrombotic agents against the risk of ICH in this patient group.

Main Methods:

  • Prospective study of 908 acute ischemic stroke patients (1999-2004).
  • Magnetic resonance imaging (MRI) used to identify and quantify cerebral microbleeds (MB).
  • Primary endpoints included subsequent ICH, recurrent cerebral infarct (CI), and mortality over a mean 26.6-month follow-up.

Main Results:

  • Cerebral microbleeds (MB) were found in 27.8% of patients.
  • ICH risk and mortality significantly increased with the quantity of MB (p < 0.001).
  • Age and MB presence/distribution were independent predictors of subsequent ICH.

Conclusions:

  • The quantity of cerebral microbleeds (MB) directly correlates with increased ICH risk and mortality.
  • While anti-thrombotic agents remain generally indicated, caution is advised for patients with ≥5 MB due to potentially outweighing ICH risks.
  • Further research on functional outcomes and anticoagulation (e.g., Coumadin) in high-MB patients is warranted.

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