Related Experiment Video
Updated: Mar 9, 2026
A Mouse Model of Hemorrhagic Transformation Induced by Acute Hyperglycemia Combined with Transient Focal Ischemia
Published on: November 15, 2024
Interaction of incidental microbleeds and prior use of antithrombotics with early hemorrhagic transformation:
Konark Malhotra1, Monica Khunger2, Bichun Ouyang3
1Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA.
Background:
Gradient echo (GRE) sequence of magnetic resonance imaging (MRI) is a sensitive tool to detect hemorrhagic transformation (HT) and old cerebral microbleeds (CMBs). Presence of CMBs and prior use of antithrombotics pose a risk of HT in ischemic stroke. We evaluated the association of CMBs and antithrombotic use with resultant HT in acute ischemic stroke (AIS).
Methods:
This retrospective study included AIS patients admitted to our center between January 2009 and August 2010 who underwent GRE-weighted MRI within 48 h of admission. Demographic and clinical data including diabetes mellitus, hypertension, hyperlipidemia, prior intake of antiplatelets/anticoagulants/statins, and presence of CMBs at admission were collected and compared between patients who developed HT and those who did not. We did a multivariate analysis using logistic regression to assess the effect of CMBs and prior use of antithrombotic agents on the risk of development for early HT in ischemic stroke.
Results:
Of 529 AIS patients, 81 (15%) were found to have HT during the initial hospital course. CMBs were found in only 9 of 81 patients (11%) with HT and in 40 out of remaining 448 patients (9%) who did not develop HT. The presence of CMBs was not associated with increased risk of HT (P = 0.53). However, prior use of antiplatelets (33% vs. 47% in the patients without HT, P = 0.02) was associated with decreased risk of HT in ischemic stroke.
Conclusion:
Presence of incidental CMBs was not associated with increased risk for early HT of an ischemic stroke. Interestingly, the prior intake of antiplatelets was found to be protective against HT of ischemic stroke.
Insights
Cerebral microbleeds (CMBs) detected by MRI do not increase hemorrhagic transformation (HT) risk in ischemic stroke patients. However, prior antiplatelet use was found to be protective against HT.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Medicine
Background:
- Gradient echo (GRE) magnetic resonance imaging (MRI) effectively detects hemorrhagic transformation (HT) and cerebral microbleeds (CMBs).
- Cerebral microbleeds (CMBs) and antithrombotic medication use are potential risk factors for HT in acute ischemic stroke (AIS).
Purpose of the Study:
- To evaluate the association between CMBs, antithrombotic use, and the risk of developing HT in patients with AIS.
- To investigate the predictive value of CMBs and prior antithrombotic intake on early HT development.
Main Methods:
- Retrospective analysis of 529 AIS patients undergoing GRE-weighted MRI within 48 hours of admission.
- Collected demographic and clinical data, including antithrombotic use and CMB presence.
- Multivariate logistic regression analysis to determine the effect of CMBs and antithrombotics on HT risk.
Main Results:
- Hemorrhagic transformation (HT) occurred in 15% of AIS patients.
- The presence of CMBs was not significantly associated with an increased risk of HT (P = 0.53).
- Prior antiplatelet use showed a decreased risk of HT (33% vs. 47%, P = 0.02).
Conclusions:
- Incidental CMBs on MRI do not elevate the risk of early HT in ischemic stroke.
- Pre-stroke antiplatelet therapy appears to have a protective effect against HT in ischemic stroke.
Related Concept Videos
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:29Venous Thrombosis III: Interprofessional Care
01:24Disorders of Hemostasis
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
01:30Venous Thrombosis IV: Nursing Management
01:05Introduction to Hemostasis
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized,...
01:20Extrinsic and Intrinsic Pathways of Hemostasis
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...