Antithrombotic Drug Use, Cerebral Microbleeds, and Intracerebral Hemorrhage: A Systematic Review of Published and Unpublished Studies

Cerebral microbleeds (MB) are potential risk factors for intracerebral hemorrhage (ICH), but it is unclear if they are a contraindication to using antithrombotic drugs. Insights could be gained by pooling data on MB frequency stratified by antithrombotic use in cohorts with ICH and ischemic stroke (...

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Published in:Stroke (1970) 2010-06, Vol.41 (6), p.1222-1228
Main Authors: LOVELOCK, Caroline E, CORDONNIER, Charlotte, BRILEY, Dennis, ROTHWELL, Peter M, NAKA, Hiromitsu, SALMAN, Rustam Al-Shahi, SUDLOW, Cathie L. M, SORIMACHI, Takatoshi, WERRING, David J, GREGOIRE, Simone M, IMAIZUMI, Toshio, LEE, Seung-Hoon
Format: Article
Language:English
Subjects:
Anticoagulants - administration & dosage
Anticoagulants - adverse effects
Biological and medical sciences
Brain Ischemia - chemically induced
Cerebral Hemorrhage - chemically induced
Female
Fibrinolytic Agents - administration & dosage
Fibrinolytic Agents - adverse effects
Humans
Male
Medical sciences
Neurology
Neuropharmacology
Neuroprotective agent
Pharmacology. Drug treatments
Risk Factors
Stroke - chemically induced
Vascular diseases and vascular malformations of the nervous system
Warfarin - administration & dosage
Warfarin - adverse effects
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Summary:Cerebral microbleeds (MB) are potential risk factors for intracerebral hemorrhage (ICH), but it is unclear if they are a contraindication to using antithrombotic drugs. Insights could be gained by pooling data on MB frequency stratified by antithrombotic use in cohorts with ICH and ischemic stroke (IS)/transient ischemic attack (TIA). We performed a systematic review of published and unpublished data from cohorts with stroke or TIA to compare the presence of MB in: (1) antithrombotic users vs nonantithrombotic users with ICH; (2) antithrombotic users vs nonusers with IS/TIA; and (3) ICH vs ischemic events stratified by antithrombotic use. We also analyzed published and unpublished follow-up data to determine the risk of ICH in antithrombotic users with MB. In a pooled analysis of 1460 ICH and 3817 IS/TIA, MB were more frequent in ICH vs IS/TIA in all treatment groups, but the excess increased from 2.8 (odds ratio; range, 2.3-3.5) in nonantithrombotic users to 5.7 (range, 3.4-9.7) in antiplatelet users and 8.0 (range, 3.5-17.8) in warfarin users (P difference=0.01). There was also an excess of MB in warfarin users vs nonusers with ICH (OR, 2.7; 95% CI, 1.6-4.4; P
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.109.572594