Cerebral microbleeds have emerged as a key MRI marker of small vessel disease and a potentially powerful predictor of future anticoagulant-associated intracerebral hemorrhage risk.
Do cerebral microbleeds on MRI predict the risk of intracerebral hemorrhage in patients receiving oral anticoagulation for atrial fibrillation?
Cerebral microbleeds identified on MRI may serve as a key biomarker for predicting the risk of devastating intracerebral hemorrhage in patients receiving oral anticoagulation for atrial fibrillation.
The increasing use of antithrombotic drugs in an aging population including anticoagulants to prevent future ischemic stroke in individuals with atrial fibrillation (AF) has been associated with a dramatic increase in the incidence of intracerebral hemorrhage (ICH) in users of antithrombotic drugs. Several lines of evidence suggest that cerebral small vessel disease (particularly sporadic cerebral amyloid angiopathy) is a risk factor for this rare but devastating complication of these commonly used treatments. Cerebral microbleeds (CMBs) have emerged as a key MRI marker of small vessel disease and a potentially powerful marker of future ICH risk, but adequately powered, high quality prospective studies of CMBs and ICH risk on anticoagulation are not available. Further data are urgently needed to determine how neuroimaging and other biomarkers may contribute to individualized risk prediction to make anticoagulation as safe and effective as possible. In this review we discuss the available evidence on cerebral small vessel disease and CMBs in the context of antithrombotic treatments, especially regarding their role as a predictor of future ICH risk after ischemic stroke, where risk-benefit judgments can be a major challenge for physicians. We will focus on patients with AF because these are frequently treated with anticoagulation. We briefly describe the rationale and design of a new prospective observational inception cohort study (Clinical Relevance of Microbleeds in Stroke; CROMIS-2) which investigates the value of MRI markers of small vessel disease (including CMBs) and genetic factors in assessing the risk of oral anticoagulation-associated ICH.
Charidimou et al. (Sun,) conducted a review in Atrial fibrillation and cerebral small vessel disease. Anticoagulants was evaluated on Intracerebral hemorrhage. Cerebral microbleeds have emerged as a key MRI marker of small vessel disease and a potentially powerful predictor of future anticoagulant-associated intracerebral hemorrhage risk.
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