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Updated: Apr 4, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Quantity of Cerebral Microbleeds, Antiplatelet Therapy, and Intracerebral Hemorrhage Outcomes: A Systematic Review
Dan-Ni Wang1, Xiao-Wen Hou2, Bo-Wen Yang2
1Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, China.
Background And Purpose:
Cerebral microbleeds (CMBs) increase future intracerebral hemorrhage (ICH) risk after ischemic stroke (IS) or transient ischemic attack (TIA). However, whether CMB-related ICH risk depends on CMB quantity, CMB location, or antithrombotic agents is unclear. We performed a systematic review and meta-analysis to investigate CMB-related ICH risk, stratifying patients according to the quantity of CMB, the location of CMB, and the type of antithrombotic therapy used.
Methods:
Literature databases were searched for prospective cohorts reporting ICH outcomes in patients with IS or TIA with baseline CMB evaluation. We calculated pooled relative ratios (RRs) for ICH among patients with and without CMBs. Pooled RRs of CMB-related ICH were further calculated in subgroups stratified by CMB quantity, CMB location, and antithrombotic therapy.
Results:
Among the 10 included studies, the pooled RR of future ICH was 7.73 (95% confidence interval [CI], 4.07-14.70; P < .001) in CMB versus non-CMB patients. Subgroup analysis revealed that compared with non-CMB patients, multiple-CMB patients were at an increased risk for future ICH (RR = 8.02; 95% CI, 3.21-20.01; P < .001), whereas single-CMB patients did not incur this risk (RR = 2.33; 95% CI, .63-8.63; P = .205). A strong association was found between CMB presence and subsequent ICH in antiplatelet users (RR = 16.56; 95% CI, 3.68-74.42; P < .001). Studies on CMB-related ICH according to CMB locations and in anticoagulant users are lacking for subgroup analysis.
Conclusion:
Our study revealed that patients with IS or TIA with multiple CMBs may incur a higher risk of future ICH, and the presence of CMBs in patients with IS or TIA using antiplatelet agents may significantly increase the subsequent ICH risk.
Insights
Multiple cerebral microbleeds (CMBs) significantly increase intracerebral hemorrhage (ICH) risk after stroke. Antiplatelet use in patients with CMBs further elevates this risk, highlighting the need for careful management.
Area of Science:
- Neurology
- Cardiovascular Research
- Radiology
Background:
- Cerebral microbleeds (CMBs) are associated with an increased risk of future intracerebral hemorrhage (ICH) following ischemic stroke (IS) or transient ischemic attack (TIA).
- The influence of CMB quantity, location, and antithrombotic therapy on ICH risk remains incompletely understood.
Purpose of the Study:
- To conduct a systematic review and meta-analysis investigating the risk of ICH in patients with CMBs.
- To stratify ICH risk based on CMB quantity, CMB location, and antithrombotic agent use.
Main Methods:
- Systematic literature search for prospective cohort studies reporting ICH outcomes in IS/TIA patients with baseline CMB assessment.
- Meta-analysis of pooled relative ratios (RRs) for ICH in patients with and without CMBs.
- Subgroup analyses based on CMB quantity, location, and antithrombotic therapy.
Main Results:
- Patients with CMBs had a significantly higher risk of future ICH (RR = 7.73).
- Multiple CMBs were associated with increased ICH risk (RR = 8.02), while single CMBs did not show a significant association (RR = 2.33).
- CMB presence significantly increased ICH risk in antiplatelet users (RR = 16.56).
Conclusions:
- Multiple CMBs in patients with IS or TIA may confer a higher risk of subsequent ICH.
- The presence of CMBs in IS/TIA patients using antiplatelet agents substantially elevates the risk of future ICH.
