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Microbleeds as a predictor of intracerebral haemorrhage and ischaemic stroke after a TIA or minor ischaemic stroke: a cohort study.

Kwa VI, Algra A, Brundel M, Bouvy W, Kappelle LJ, MICRO Study Gro - BMJ Open (2013)

Bottom Line: Primary outcome was a symptomatic ICH.The incidences of ischaemic stroke, vascular death, non-vascular death and death of all causes were higher in patients with microbleeds, but not statistically significant.In our cohort of patients using antithrombotic drugs after a TIA or minor ischaemic stroke, we found that microbleeds on MRI are associated with an increased risk of future stroke in general, but we did not find an increased risk of symptomatic ICH.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Onze Lieve Vrouwe Gasthuis,Slotervaart Hospital, Amsterdam, The Netherlands.

ABSTRACT

Objectives: We examined whether patients with cerebral microbleeds on MRI, who started and continued antithrombotic medication for years, have an increased risk of symptomatic intracerebral haemorrhage (ICH).

Design: Prospective cohort study.

Settings: Multicentre outpatient clinics in the Netherlands.

Participants: We followed 397 patients with newly diagnosed transient ischaemic attack (TIA) or minor ischaemic stroke receiving anticoagulants or antiplatelet drugs. 58% were men. The mean age was 65.3 years. 395 (99%) patients were white Europeans. MRI including a T2*-weighted gradient echo was performed within 3 months after start of medication. 48 (12%) patients had one or more microbleeds. They were followed every 6 months by telephone for a mean of 3.8 years.

Primary and secondary outcome measures: Primary outcome was a symptomatic ICH. Secondary outcome were all strokes, ischaemic stroke, myocardial infarct, death from all vascular causes, death from non-vascular causes and death from all causes.

Results: Five patients (1%) suffered from a symptomatic ICH. One ICH occurred in a patient with microbleeds at baseline (adjusted HR 2.6, 95% CI 0.3 to 27). The incidence of all strokes during follow-up was higher in patients with than without microbleeds (adjusted HR 2.3, 95% CI 1.0 to 5.3), with a dose-response relationship. The incidences of ischaemic stroke, vascular death, non-vascular death and death of all causes were higher in patients with microbleeds, but not statistically significant.

Conclusions: In our cohort of patients using antithrombotic drugs after a TIA or minor ischaemic stroke, we found that microbleeds on MRI are associated with an increased risk of future stroke in general, but we did not find an increased risk of symptomatic ICH.

No MeSH data available.


Related in: MedlinePlus

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BMJOPEN2013002575F1: Flow chart of the study.

Mentions: We included 448 patients, of whom 51 did not have an FFE-gradient echo series during the MRI due to various reasons, leaving 397 analysable patients (figure 1). Patients who did not have an FFE-gradient echo MRI were, on average, 5 years younger, smoked more often (45% vs 27%) and had hyperlipidaemia (20% vs 42%) or atrial fibrillation (0% vs 8%) less frequently than patients who had an FFE-gradient echo MRI. There were no other differences between the two groups concerning sex, ethnicity, Rankin scores and other vascular risk factors (see online supplementary table S3).


Microbleeds as a predictor of intracerebral haemorrhage and ischaemic stroke after a TIA or minor ischaemic stroke: a cohort study.

Kwa VI, Algra A, Brundel M, Bouvy W, Kappelle LJ, MICRO Study Gro - BMJ Open (2013)

Flow chart of the study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4401818&req=5

BMJOPEN2013002575F1: Flow chart of the study.
Mentions: We included 448 patients, of whom 51 did not have an FFE-gradient echo series during the MRI due to various reasons, leaving 397 analysable patients (figure 1). Patients who did not have an FFE-gradient echo MRI were, on average, 5 years younger, smoked more often (45% vs 27%) and had hyperlipidaemia (20% vs 42%) or atrial fibrillation (0% vs 8%) less frequently than patients who had an FFE-gradient echo MRI. There were no other differences between the two groups concerning sex, ethnicity, Rankin scores and other vascular risk factors (see online supplementary table S3).

Bottom Line: Primary outcome was a symptomatic ICH.The incidences of ischaemic stroke, vascular death, non-vascular death and death of all causes were higher in patients with microbleeds, but not statistically significant.In our cohort of patients using antithrombotic drugs after a TIA or minor ischaemic stroke, we found that microbleeds on MRI are associated with an increased risk of future stroke in general, but we did not find an increased risk of symptomatic ICH.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Onze Lieve Vrouwe Gasthuis,Slotervaart Hospital, Amsterdam, The Netherlands.

ABSTRACT

Objectives: We examined whether patients with cerebral microbleeds on MRI, who started and continued antithrombotic medication for years, have an increased risk of symptomatic intracerebral haemorrhage (ICH).

Design: Prospective cohort study.

Settings: Multicentre outpatient clinics in the Netherlands.

Participants: We followed 397 patients with newly diagnosed transient ischaemic attack (TIA) or minor ischaemic stroke receiving anticoagulants or antiplatelet drugs. 58% were men. The mean age was 65.3 years. 395 (99%) patients were white Europeans. MRI including a T2*-weighted gradient echo was performed within 3 months after start of medication. 48 (12%) patients had one or more microbleeds. They were followed every 6 months by telephone for a mean of 3.8 years.

Primary and secondary outcome measures: Primary outcome was a symptomatic ICH. Secondary outcome were all strokes, ischaemic stroke, myocardial infarct, death from all vascular causes, death from non-vascular causes and death from all causes.

Results: Five patients (1%) suffered from a symptomatic ICH. One ICH occurred in a patient with microbleeds at baseline (adjusted HR 2.6, 95% CI 0.3 to 27). The incidence of all strokes during follow-up was higher in patients with than without microbleeds (adjusted HR 2.3, 95% CI 1.0 to 5.3), with a dose-response relationship. The incidences of ischaemic stroke, vascular death, non-vascular death and death of all causes were higher in patients with microbleeds, but not statistically significant.

Conclusions: In our cohort of patients using antithrombotic drugs after a TIA or minor ischaemic stroke, we found that microbleeds on MRI are associated with an increased risk of future stroke in general, but we did not find an increased risk of symptomatic ICH.

No MeSH data available.


Related in: MedlinePlus