Brain microbleeds as a potential risk factor for antiplatelet-related intracerebral haemorrhage: hospital-based, case-control study

Simone M Gregoire (1) , Hans R Jager (2) , Tarek A Yousry (2) , Constantinos Kallis (3) , Martin M Brown (2) , David J Werring (2)

1 UCL Institute of Neurology, Queen Square [London]
2 UCL Institute of neurology
3 LSHTM - London School of Hygiene and Tropical Medicine

Background: Intracerebral haemorrhage (ICH) is an uncommon but devastating complication of regular antiplatelet use: identifying high risk patients before treatment could potentially reduce this hazard. Brain microbleeds on gradient-recalled echo (GRE) T2*-weighted MRI are considered a biomarker for bleeding-prone small vessel diseases. We hypothesized that microbleeds are a risk factor for antiplatelet-related ICH, and investigated this in a hospital-based matched case-control study. Methods: Cases of spontaneous ICH were ascertained, using overlapping methods, from a prospective database of 1017 consecutive unselected patients referred to our stroke unit and associated clinics. For each case of antiplatelet-related ICH, 2 controls matched for age, sex and hypertension without history of ICH on antiplatelet therapy were selected. Microbleeds were identified by a trained observer blinded to clinical details. Results: Microbleeds were more frequent in antiplatelet users with ICH than in matched antiplatelet users without ICH (13/16[81%] vs 6/32[19%], p=0.004) and patients with non antiplatelet-related ICH (13/16[81%] vs 15/33[45%], p=0.03). The frequency of lobar microbleeds was 11/16[69%] in antiplatelet-related ICH vs 11/33[33%] in non antiplatelet-related ICH (p=0.032). Microbleeds were more numerouse in antiplatelet users with ICH compared to controls (p=0.016). The number of microbleeds was associated with the risk of antiplatelet-related ICH (adjusted OR 1.33 per additional microbleed, 95%CI 1.06-1.66, p=0.013). Conclusions: Brain microbleeds are associated with antiplatelet-related ICH. In patients with a large number of lobar microbleeds, the risk of ICH could outweigh the benefits of antiplatelet therapy. Larger prospective studies to investigate the prognostic significance of microbleeds in long-term antiplatelet users are warranted.

Mots clés: CEREBROVASCULAR DISEASE; PLATELETS; STROKE

Simone M Gregoire, Hans R Jager, Tarek A Yousry, Constantinos Kallis, Martin M Brown, et al.. Brain microbleeds as a potential risk factor for antiplatelet-related intracerebral haemorrhage: hospital-based, case-control study. Journal of Neurology, Neurosurgery and Psychiatry, 2010, 81 (6), pp.679. ⟨10.1136/jnnp.2009.198994⟩. ⟨hal-00557436⟩