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Antithrombotic therapy in patients with cerebral microbleeds

Wilson, D; Werring, DJ; (2017) Antithrombotic therapy in patients with cerebral microbleeds. Current Opinion in Neurology , 30 (1) pp. 38-47. 10.1097/WCO.0000000000000411. Green open access

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Abstract

PURPOSE OF REVIEW: Cerebral microbleeds (CMBs) are a radiological marker of cerebral small vessel disease corresponding to small haemosiderin foci identified by blood-sensitive MRI. CMBs are common in older community populations, and in individuals with ischaemic stroke or transient ischaemic attack (TIA), and intracerebral haemorrhage (ICH). We summarize how CMBs might contribute to assessing the future risk of ischaemic stroke and ICH to inform antithrombotic (antiplatelet or anticoagulant) decisions. RECENT FINDINGS: CMBs are a risk factor for future ischaemic stroke and ICH in all community and hospital populations studied. Following ischaemic stroke/TIA treated with antithrombotics, increasing CMB burden increases the risk of ICH more steeply than that of ischaemic stroke. In ICH populations the risk of recurrent ICH increases with CMB burden, and is highest in those with strictly lobar CMBs or other haemorrhagic findings (e.g. cortical superficial siderosis) suggesting cerebral amyloid angiopathy (CAA). SUMMARY: In ischaemic stroke or patients with TIA less than five CMBs should not affect antithrombotic decisions, although with more than five CMBs the risks of future ICH and ischaemic stroke are finely balanced, and antithrombotics might cause net harm. In lobar ICH populations, a high burden of strictly lobar CMBs is associated with CAA and high ICH risk; antithrombotics should be avoided unless there is a compelling indication.

Type: Article
Title: Antithrombotic therapy in patients with cerebral microbleeds
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/WCO.0000000000000411
Publisher version: http://doi.org/10.1097/WCO.0000000000000411
Language: English
Additional information: Copyright © 2017 Wolters Kluwer Health, Inc. All rights resereved. This manuscript version is published under a Creative Commons Attribution Non-commercial 4.0 International licence (CC BY-NC 4.0). This licence allows you to share, copy, distribute and transmit the work for personal and non-commercial use providing author and publisher attribution is clearly stated. Further details about CC BY licences are available at http://creativecommons.org/licenses/by/4.0. Access may be initially restricted by the publisher.
Keywords: Cerebral microbleeds, antithormbotics, anticoagulants, antiplatelets, ischaemic stroke, intracerebral haemorrhage
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Brain Repair and Rehabilitation
URI: https://discovery.ucl.ac.uk/id/eprint/1533965
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