Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-24T21:41:43.775Z Has data issue: false hasContentIssue false

Aspirin Treatment Increases the Risk of Cerebral Microbleeds

Published online by Cambridge University Press:  02 December 2014

Lihong Ge
Affiliation:
Department of Imaging, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing
Guangming Niu*
Affiliation:
Department of Imaging, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing Department of Magnetic Resonance, The Affiliated Hospital of Inner Mongolia Medical College, Hohhot, China
Xiaodong Han
Affiliation:
Department of Magnetic Resonance, The Affiliated Hospital of Inner Mongolia Medical College, Hohhot, China
Yang Gao
Affiliation:
Department of Magnetic Resonance, The Affiliated Hospital of Inner Mongolia Medical College, Hohhot, China
Qiong Wu
Affiliation:
Department of Magnetic Resonance, The Affiliated Hospital of Inner Mongolia Medical College, Hohhot, China
Hui Wu
Affiliation:
Department of Magnetic Resonance, The Affiliated Hospital of Inner Mongolia Medical College, Hohhot, China
Ying Zhang
Affiliation:
Department of Magnetic Resonance, The Affiliated Hospital of Inner Mongolia Medical College, Hohhot, China
Dongling Guo
Affiliation:
Department of Magnetic Resonance, The Affiliated Hospital of Inner Mongolia Medical College, Hohhot, China
*
Department of Imaging, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, 100050, China.
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

The objective of the study was to determine the frequency of cerebral microbleeds (CMBs) by using phasesensitive imaging in patients with previous transient ischemic attack (TIA) or stroke who were receiving aspirin treatment.

Methods:

We retrospectively analyzed 300 outpatients with ischemic cerebrovascular disease: 150 had been receiving aspirin treatment for >1 year (patients), and 150 controls had not previously received aspirin. Cerebral microbleeds were defined by a trained observer (blinded to clinical details) according to results of T2-weighted, T1-weighted, diffusion-weighted, and phase-sensitive magnetic resonance imaging (MRI). Numerous vascular risk factors including white matter hyperintensity (WMH), duration of aspirin treatment, age, hypertension or diabetes mellitus were investigated for a possible association with the presence of CMBs in the two groups.

Results:

The frequency of CMBs (60/150 (40%) vs 18/150 (12%); odds ratio 4.899, p <0.0001) and intracerebral hemorrhage (ICH)(42/150 (28%) vs 2/150 (1%); odds ratio 28.778, p <0.0001) were significantly higher in the patients than in the controls. Among patients, those using aspirin for >5 years(42/68 (62%) showed a higher frequency of CMBs than those receiving aspirin for ≤ 5 years(18/82 (22%); odds ratio 5.744, p<0.0001). WMH (p=0.020/0.030, 0.007/0.000) age (p=0.007/0.000) and hypertension (p=0.000/0.033), in patients and controls respectively, were each associated with CMBs.

Conclusions:

There was a clear impact of aspirin treatment on CMBs associated with intracerebral hemorrhage in Chinese patients. The frequency of CMBs and hemorrhagic complications was higher in patients treated with long-term aspirin.

Type
Original Articles
Copyright
Copyright © The Canadian Journal of Neurological 2011

References

1.Baigent, C, Blackwell, L, Collins, R, et al.Aspirin in the primary and secondary prevention of vascular disease: collaborative metaanalysis of individual participant data from randomised trials. Lancet. 2009;373(9678):184960.Google Scholar
2.Gorelick, PB, Weisman, SM.Risk of hemorrhagic stroke with aspirin use: an update. Stroke. 2005;36(8):18017.Google Scholar
3.Boysen, G.Bleeding complications in secondary stroke prevention by antiplatelet therapy: a benefit-risk analysis. J Intern Med. 1999;246(3):23945.Google Scholar
4.Naidech, AM, Bendok, BR, Garg, RK, et al.Reduced platelet activity is associated with more intraventricular hemorrhage. Neurosurgery. 2009;65(4):68488; discussion 688.Google Scholar
5.Offenbacher, H, Fazekas, F, Schmidt, R, et al.MR of cerebral abnormalities concomitant with primary intracerebral hematomas. AJNR Am J Neuroradiol. 1996;17(3):5738.Google Scholar
6.Fazekas, F, Kleinert, R, Roob, G, et al.Histopathologic analysis of foci of signal loss on gradient-echo T2*-weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds. AJNR Am J Neuroradiol. 1999;20(4):63742.Google Scholar
7.Han, J, Gao, P, Lin, Y, et al.Three-tesla magnetic resonance imaging study of cerebral microbleeds in patients with ischemic stroke. Neurol Res. 2009;31(9):9003.Google Scholar
8.Roob, G, Lechner, A, Schmidt, R, et al.Frequency and location of microbleeds in patients with primary intracerebral hemorrhage. Stroke. 2000;31(11):26659.Google Scholar
9.Lovelock, CE, Cordonnier, C, Naka, H, et al.Antithrombotic drug use, cerebral microbleeds, and intracerebral hemorrhage: a systematic review of published and unpublished studies. Stroke. 2010;41(6):12228.CrossRefGoogle ScholarPubMed
10.Vernooij, MW, Haag, MD, van der Lugt, A, et al.Use of antithrombotic drugs and the presence of cerebral microbleeds: the Rotterdam Scan Study. Arch Neurol. 2009;66(6):71420.Google Scholar
11.Leys, D, Cordonnier, C.Brain microbleeds as a potential risk factor for antiplatelet-related intracerebral haemorrhage. J Neurol Neurosurg Psychiatry. 2010;81(6):58990.Google Scholar
12.Gregoire, SM, Jager, HR, Yousry, TA, et al.Brain microbleeds as a potential risk factor for antiplatelet-related intracerebral haemorrhage: hospital-based, case-control study. J Neurol Neurosurg Psychiatry. 2010;81(6):67984.Google Scholar
13.Soo, YO, Yang, SR, Lam, WW, et al.Risk vs benefit of antithrombotic therapy in ischaemic stroke patients with cerebral microbleeds. J Neurol. 2008;255(11):167986.Google Scholar
14.Orken, DN, Kenangil, G, Uysal, E, et al.Cerebral microbleeds in ischemic stroke patients on warfarin treatment. Stroke. 2009;40(11):363840.Google Scholar
15.Ueno, H, Naka, H, Ohshita, T, et al.Association between cerebral microbleeds on T2*-weighted MR images and recurrent hemorrhagic stroke in patients treated with warfarin following ischemic stroke. AJNR Am J Neuroradiol. 2008;29(8):14836.Google Scholar
16.Nishikawa, T, Ueba, T, Kajiwara, M, et al.Cerebral microbleeds in patients with intracerebral hemorrhage are associated with previous cerebrovascular diseases and white matter hyperintensity, but not with regular use of antiplatelet agents. Neurol Med Chir (Tokyo). 2009;49(8):3339; discussion 338-9.Google Scholar
17.Nandigam, RN, Viswanathan, A, Delgado, P, et al.MR imaging detection of cerebral microbleeds: effect of susceptibilityweighted imaging, section thickness, and field strength. AJNR Am J Neuroradiol. 2009;30(2):33843.Google Scholar
18.Lee, SH, Bae, HJ, Yoon, BW, et al.Low concentration of serum total cholesterol is associated with multifocal signal loss lesions on gradient-echo magnetic resonance imaging: analysis of risk factors for multifocal signal loss lesions. Stroke. 2002;33(12): 28459.CrossRefGoogle ScholarPubMed
19.Fazekas, F, Chawluk, JB, Alavi, A, et al.MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol. 1987;149(2):3516.Google Scholar
20.Naidech, AM, Jovanovic, B, Liebling, S, et al.Reduced platelet activity is associated with early clot growth and worse 3-month outcome after intracerebral hemorrhage. Stroke. 2009;40(7): 2398401.Google Scholar
21.Roob, G, Schmidt, R, Kapeller, P, et al.MRI evidence of past cerebral microbleeds in a healthy elderly population. Neurology. 1999;52(5):9914.Google Scholar
22.Liu, PF, Cui, YZ, Na, J, Gao, PY.Cerebral microbleeds - prevalence, distribution and risk factors in northeast population without preceding large-area stroke. Chin Med J (Engl). 2010;123: 28690.Google Scholar
23.Nighoghossian, N, Hermier, M, Adeleine, P, et al.Old microbleeds are a potential risk factor for cerebral bleeding after ischemic stroke: a gradient-echo T2*-weighted brain MRI study. Stroke. 2002; 33(3):73542.Google Scholar
24.Naidech, AM, Bernstein, RA, Levasseur, K, et al.Platelet activity and outcome after intracerebral hemorrhage. Ann Neurol. 2009;65(3):3526.CrossRefGoogle ScholarPubMed