Antiplatelet Therapy as a Risk Factor for Microbleeds in Intracerebral Hemorrhage Patients: Analysis Using Specific Antiplatelet Agents

Naka, Hiroyuki; Nomura, Eiichi; Kitamura, Jyuri; Imamura, Eiji; Wakabayashi, Shigeo; Matsumoto, Masayasu

doi:10.1016/j.jstrokecerebrovasdis.2012.06.001

Cited by 33 publications

(18 citation statements)

References 20 publications

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“…22,23 A Japanese study found that antiplatelet use was associated with the presence of CMBs in 412 patients with ICH (OR, 2.418; CI, 1.236-4.730) but not in 1502 patients with ischemic stroke. 24 In patients with ICH, aspirin (OR, 2.160; CI, 1.050-4.443), but not clopidogrel, cilostazol, or ticlopidine, was associated with CMBs, especially deep CMBs. 24 However, several studies revealed no association between antithrombotic therapy and the risk of CMBs.…”

Section: Do Patients Taking Antithrombotic Therapy Develop More Cmbs?mentioning

confidence: 94%

“…24 In patients with ICH, aspirin (OR, 2.160; CI, 1.050-4.443), but not clopidogrel, cilostazol, or ticlopidine, was associated with CMBs, especially deep CMBs. 24 However, several studies revealed no association between antithrombotic therapy and the risk of CMBs. Most of these studies had small sample sizes, except a Korean study with 1452 asymptomatic elderly patients, 26 as shown in Table 1.…”

Section: Do Patients Taking Antithrombotic Therapy Develop More Cmbs?mentioning

confidence: 94%

“…39,40 In contrast, some studies discovered the association between aspirin or clopidogrel use and a higher prevalence of deep/infratentorial CMBs, instead of strictly lobar CMBs. 20,24 Definitive data about the impact of CMBs location on recurrent ICH are lacking.…”

Section: Recommendations and Future Directionsmentioning

confidence: 99%

See 2 more Smart Citations

Cerebral Microbleeds

Wang

Soo

Mok

2014

Stroke

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Section: Do Patients Taking Antithrombotic Therapy Develop More Cmbs?mentioning

confidence: 94%

Section: Do Patients Taking Antithrombotic Therapy Develop More Cmbs?mentioning

confidence: 94%

See 1 more Smart Citation

Cerebral Microbleeds

Wang

Soo

Mok

2014

Stroke

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“…Significant associations have been consistently reported between CMBs and advanced age, as well as hypertension 33. In contrast, association between CMBs and diabetes has been inconsistent across published reports 19,34,35. The Rotterdam Scan Study described CMBs in 1,062 older subjects 39.…”

Section: Prevalence and Associated Factors For Cerebral Microbleedsmentioning

confidence: 99%

Cerebral Microbleeds: Their Associated Factors, Radiologic Findings, and Clinical Implications

Kim

Lee

2013

J Stroke

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Cerebral microbleeds (CMBs) are tiny, round dark-signal lesions that are most often detected on gradient-echo MR images. CMBs consist of extravasations of blood components through fragile microvascular walls characterized by lipohyalinosis and surrounding macrophages. The prevalence of CMBs in elderly subjects with no history of cerebrovascular disease is around 5%, but is much higher in patients with ischemic or hemorrhagic stroke. Development of CMBs is closely related to various vascular risk factors; in particular, lobar CMBs are thought to be associated with cerebral amyloid angiopathy. The presence of CMBs has been hypothesized to reflect cerebral-hemorrhage-prone status in patients with hypertension or amyloid microangiopathy. Stroke survivors with CMBs have been consistently found to have an elevated risk of subsequent hemorrhagic stroke or an antithrombotic-related hemorrhagic complication, although studies have failed to establish a link between CMBs and hemorrhagic transformation after thrombolytic treatment. A large prospective study is required to clarify the clinical significance of CMBs and their utility in a decision-making index.

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“…22 ASA, but not other antiplatelet medications, was associated with CMH in patients presenting with ICH. 23 A major determinant of safety of ASA use in patients with preexisting CMH (who have not had an ICH) appears to be the quantity of CMH. In 252 patients with a history of IS and known CMH, the benefit of ASA use outweighs the risk of ICH unless $5 CMH were present.…”

mentioning

confidence: 99%

Aspirin and intracerebral hemorrhage

Behrouz

Miller

2015

Neur Clin Pract

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SummaryFor the past 3 decades, aspirin has been widely used for prevention of ischemic stroke and myocardial infarction. Although the evidence supporting the effectiveness of aspirin in prevention of vascular events is clear, data regarding the risk of acute and recurrent intracerebral hemorrhage related to the use of this medication have been conflicting. We review past and contemporary data on aspirin use in relation to intracerebral hemorrhage.A spirin, or acetylsalicylic acid (ASA), was synthesized in 1897 by the German chemist Felix Hoffmann.1 Its original and current indication is for control of pain and inflammation. Seventy years after its initial formulation, ASA was shown to block platelet aggregation by inhibition of thromboxane A 2 .2 Now it is well-known that ASA is effective in prevention of myocardial infarction (MI) and ischemic stroke (IS) and has been used in that capacity for the past 3 decades.3 Since its expanded utilization, the risk of bleeding has been a concern for physicians. For neurologists, this concern particularly involves balancing the risk of intracerebral hemorrhage (ICH) with the benefits afforded by IS prevention. The effectiveness of ASA in prevention of IS is indisputable. A meta-analysis of 18 trials reported a 23% reduction in IS risk with antiplatelet therapy. 4 Because of its widespread availability and low cost, ASA is the most widely used drug in the world.5 However, studies regarding the effect of prior ASA use on ICH development, growth, and outcome have found conflicting results. The authors present past data and the most recent information on ASA use and ICH. PharmacologyThe antithrombotic property of ASA is related to its inhibition of the cyclooxygenase (COX)

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Antiplatelet Therapy as a Risk Factor for Microbleeds in Intracerebral Hemorrhage Patients: Analysis Using Specific Antiplatelet Agents

Cited by 33 publications

References 20 publications

Cerebral Microbleeds

Cerebral Microbleeds

Cerebral Microbleeds: Their Associated Factors, Radiologic Findings, and Clinical Implications

Aspirin and intracerebral hemorrhage

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