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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

Cumulative number of any kind of strokes in patients with microbleeds (dotted line) or without microbleeds (straight line).
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BMJOPEN2013002575F2: Cumulative number of any kind of strokes in patients with microbleeds (dotted line) or without microbleeds (straight line).

Mentions: The incidence of all strokes was higher in patients with microbleeds (crude HR 2.6, 95% CI 1.1 to 6.2), also after correction for age and sex (HR 2.3, 95% CI 1.0 to 5.3; figure 2). The more microbleeds a patient had, the higher was the risk for future strokes (table 3). The incidence of ischaemic strokes was also higher in patients with microbleeds, but the HRs did not reach statistical significance. Interestingly, of the ischaemic strokes in patients with microbleeds, the proportion of lacunar infarcts (67%) was larger than that in patients without microbleeds (35%), but again this was not statistically significant (see online supplementary table S4). The incidence of myocardial infarction was low and did not occur at all in patients with microbleeds. Vascular deaths, non-vascular deaths and deaths of all causes were also more frequent in patients with microbleeds, but did not reach statistical significance.


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)

Cumulative number of any kind of strokes in patients with microbleeds (dotted line) or without microbleeds (straight line).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

BMJOPEN2013002575F2: Cumulative number of any kind of strokes in patients with microbleeds (dotted line) or without microbleeds (straight line).
Mentions: The incidence of all strokes was higher in patients with microbleeds (crude HR 2.6, 95% CI 1.1 to 6.2), also after correction for age and sex (HR 2.3, 95% CI 1.0 to 5.3; figure 2). The more microbleeds a patient had, the higher was the risk for future strokes (table 3). The incidence of ischaemic strokes was also higher in patients with microbleeds, but the HRs did not reach statistical significance. Interestingly, of the ischaemic strokes in patients with microbleeds, the proportion of lacunar infarcts (67%) was larger than that in patients without microbleeds (35%), but again this was not statistically significant (see online supplementary table S4). The incidence of myocardial infarction was low and did not occur at all in patients with microbleeds. Vascular deaths, non-vascular deaths and deaths of all causes were also more frequent in patients with microbleeds, but did not reach statistical significance.

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