Cerebral microbleeds on MRI may flag higher sICH risk

CROMIS-2, an observational study, suggests that patients with atrial fibrillation (AF) who are receiving anticoagulation after a recent ischemic stroke or transient ischemic attack (TIA) are at increased risk for symptomatic intracranial hemorrhage (sICH) when MRI shows cerebral microbleeds.

Based on 2 years of follow-up in 1447 patients, the symptomatic intracranial hemorrhage rate was 9.8 per 1000 patient-years among those with microbleeds vs 2.6 among those without microbleeds, the primary outcome of the Clinical Relevance of Microbleeds in Stroke (CROMIS-2) trial.

Dilemma
Results were published online May 16 in Lancet Neurology and presented at the 4th European Stroke Organisation Conference (ESOC) 2018. “This is an increasingly common clinical dilemma — we have a patient with ischemic stroke or transient ischemic attack who has atrial fibrillation. We take an MRI scan with blood-sensitive imaging, and this shows cerebral microbleeds,” David Werring, MBBs, PhD, lead researcher at the Stroke Research Centre and professor of neurology at the University College London Institute of Neurology, United Kingdom, said. “The priority is to reduce the risk of ischemic stroke,” he said. Oral anticoagulants are extremely effective, with a relative risk reduction of about 70%, “but this is at the cost of a rare and unpredictable consequence, which is intracranial hemorrhage,” added Werring.

 

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Source: MedScape | May 18, 2018

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