Abstract
In patients with transient ischemic attack/ischemic stroke, microbleed burden predicts intracerebral hemorrhage (ICH), and ischemic stroke, but implications for antiplatelet treatment are uncertain. Previous cohort studies have had insufficient follow-up to assess the time course of risks, have not stratified risks by antithrombotic use, and have not reported extracranial bleeds or functional outcome of ICH versus ischemic stroke. In 2 independent prospective cohorts with transient ischemic attack/ischemic stroke (Oxford Vascular Study/mainly white; University of Hong Kong/mainly Chinese), antiplatelet treatment was started routinely irrespective of microbleed burden. Risks, time course and outcome of ICH, extracranial bleeds, and recurrent ischemic events were determined and stratified by microbleed burden (0 versus 1, 2-4, and ≥5), adjusting for age, sex, and vascular risk factors. Microbleeds were more frequent in the Chinese cohort (450 of 1003 versus 165 of 1080; P<0.0001), but risk associations were similar during 7433 patient-years of follow-up. Among 1811 patients on antiplatelet drugs, risk of major extracranial bleeds was unrelated to microbleed burden (Ptrend=0.87), but the 5-year risk of ICH was steeply related (Ptr...Continue Reading
References
Aug 1, 1987·AJR. American Journal of Roentgenology·F FazekasR A Zimmerman
Mar 13, 1999·Annals of Internal Medicine·A S LeveyD Roth
Jan 12, 2002·BMJ : British Medical Journal·UNKNOWN Antithrombotic Trialists' Collaboration
Jun 15, 2004·Lancet·P M RothwellUNKNOWN Oxford Vascular Study
Dec 3, 2005·Stroke; a Journal of Cerebral Circulation·Pertti SaloheimoMatti Hillbom
Feb 27, 2007·Brain : a Journal of Neurology·Charlotte CordonnierJoanna Wardlaw
Nov 13, 2007·Lancet Neurology·Matthew F Giles, Peter M Rothwell
Jun 24, 2008·Academic Radiology·Christoph StehlingWalter Heindel
Jan 24, 2009·Lancet Neurology·Steven M GreenbergUNKNOWN Microbleed Study Group
Nov 26, 2009·Neurology·S M GregoireD J Werring
Apr 13, 2010·Clinical Radiology·S M GregoireH R Jäger
Apr 28, 2010·Neurology·J LinnS M Greenberg
May 1, 2010·Stroke; a Journal of Cerebral Circulation·Caroline E LovelockPeter M Rothwell
Sep 29, 2011·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·F FluriS T Engelter
Nov 23, 2011·Cerebrovascular Diseases·A ShoamaneshO Benavente
Jul 13, 2012·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Hiromitsu NakaMasayasu Matsumoto
Jul 17, 2012·Stroke; a Journal of Cerebral Circulation·Andreas CharidimouDavid J Werring
Mar 16, 2013·Stroke; a Journal of Cerebral Circulation·Andreas CharidimouDavid J Werring
Jul 23, 2013·Lancet Neurology·Joanna M WardlawUNKNOWN STandards for ReportIng Vascular changes on nEuroimaging (STRIVE v1)
Aug 8, 2013·Stroke; a Journal of Cerebral Circulation·Ah-Ling ChengEric E Smith
Jun 28, 2014·Cerebrovascular Diseases·Saloua AkoudadMeike W Vernooij
Sep 5, 2014·Neurology·Mark Fisher
Jan 13, 2015·JAMA Neurology·Jae-Sung LimYong-Seok Lee
Apr 1, 2015·Cerebrovascular Diseases·Gillian M PotterJoanna M Wardlaw
Feb 5, 2016·Neurology·Susanne J van VeluwAnnemieke J M Rozemuller
May 23, 2016·Lancet·Peter M RothwellZiyah Mehta
Sep 4, 2016·Neurology·Duncan WilsonDavid J Werring
Sep 21, 2016·Lancet Neurology·UNKNOWN Microbleeds International Collaborative Network
Nov 30, 2016·Current Opinion in Neurology·Duncan Wilson, David J Werring
May 13, 2017·Stroke; a Journal of Cerebral Circulation·Kui-Kai LauPeter M Rothwell
May 19, 2017·Neurology·Kui Kai LauPeter M Rothwell
Dec 9, 2017·Journal of the American Heart Association·Kui Kai LauHenry Ka Fung Mak
Jan 26, 2018·Stroke; a Journal of Cerebral Circulation·William J PowersUNKNOWN American Heart Association Stroke Council
Citations
Aug 21, 2020·The Journal of International Medical Research·Ningqin MengChao Qin
Oct 26, 2018·Stroke; a Journal of Cerebral Circulation·Hamidreza Saber
Sep 15, 2018·Stroke; a Journal of Cerebral Circulation·Kui Kai Lau, Peter M Rothwell
Nov 13, 2018·Clinical Neuropharmacology·Yifan LiangMei Zhao
Sep 27, 2018·Current Atherosclerosis Reports·Carlo W Cereda, Jean-Marc Olivot
Nov 30, 2018·Neuroradiology·Ge-Fei LiJian-Ren Liu
Aug 5, 2020·Revue neurologique·B Casolla, C Cordonnier
Oct 27, 2020·Curēus·Hassan Kesserwani
May 1, 2021·Frontiers in Neurology·Ping-Song ChouA-Ching Chao
Jul 20, 2021·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Toshihide NaganumaAyumi Shintani
Aug 10, 2021·Journal of the American Heart Association·Kui-Kai LauHenry Ka-Fung Mak
Sep 4, 2021·The Neuroradiology Journal·Keisuke KoizumiTakao Hashimoto