BACKGROUND AND PURPOSE: Cerebral microbleeds (MB) are potential risk factors for intracerebral hemorrhage (ICH), but it is unclear if they are a contraindication to using antithrombotic drugs. Insights could be gained by pooling data on MB frequency stratified by antithrombotic use in cohorts with ICH and ischemic stroke (IS)/transient ischemic attack (TIA). METHODS: We performed a systematic review of published and unpublished data from cohorts with stroke or TIA to compare the presence of MB in: (1) antithrombotic users vs nonantithrombotic users with ICH; (2) antithrombotic users vs nonusers with IS/TIA; and (3) ICH vs ischemic events stratified by antithrombotic use. We also analyzed published and unpublished follow-up data to determine the risk of ICH in antithrombotic users with MB. RESULTS: In a pooled analysis of 1460 ICH and 3817 IS/TIA, MB were more frequent in ICH vs IS/TIA in all treatment groups, but the excess increased from 2.8 (odds ratio; range, 2.3-3.5) in nonantithrombotic users to 5.7 (range, 3.4-9.7) in antiplatelet users and 8.0 (range, 3.5-17.8) in warfarin users (P difference=0.01). There was also an excess of MB in warfarin users vs nonusers with ICH (OR, 2.7; 95% CI, 1.6-4.4; P<0.001) but none in warfarin users with IS/TIA (OR, 1.3; 95% CI, 0.9-1.7; P=0.33; P difference=0.01). There was a smaller excess of MB in antiplatelet users vs nonusers with ICH (OR, 1.7; 95% CI, 1.3-2.3; P<0.001), but findings were similar for antiplatelet users with IS/TIA (OR, 1.4; 95% CI, 1.2-1.7; P<0.001; P difference=0.25). In pooled follow-up data for 768 antithrombotic users, presence of MB at baseline was associated with a substantially increased risk of subsequent ICH (OR, 12.1; 95% CI, 3.4-42.5; P<0.001). CONCLUSIONS: The excess of MB in warfarin users with ICH compared to other groups suggests that MB increase the risk of warfarin-associated ICH. Limited prospective data corroborate these findings, but larger prospective studies are urgently required.
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机译：背景与目的：脑微出血（MB）是脑出血（ICH）的潜在危险因素，但目前尚不清楚它们是否是使用抗血栓药物的禁忌症。通过收集ICH，缺血性卒中（IS）/短暂性脑缺血发作（TIA）人群中抗血栓使用分层的MB频率数据，可以得到洞察力。方法：我们对卒中或TIA人群的已发表和未发表数据进行了系统的回顾，以比较MB在以下人群中的存在：（1）ICH的抗血栓药物使用者和非抗血栓药物使用者; （2）使用IS / TIA的抗血栓使用者与非血栓使用者; （3）ICH与缺血事件之间以抗血栓形成分层。我们还分析了已发表和未发表的随访数据，以确定MB的抗血栓形成者发生ICH的风险。结果：在对1460 ICH和3817 IS / TIA的汇总分析中，在所有治疗组中ICH相对于IS / TIA的MB发生率更高，但从非抗血栓形成者的2.8（优势比;范围2.3-3.5）增加到抗血小板药物使用者为5.7（3.4-9.7范围），华法林药物使用者为8.0（3.5-17.8）（P差= 0.01）。华法林使用者与非ICH使用者相比，MB过多（OR，2.7; 95％CI，1.6-4.4; P <0.001），而IS / TIA的华法林使用者则无MB（OR，1.3; 95％CI，0.9 -1.7; P ＝ 0.33; P差＝ 0.01）。与使用ICH的非血小板使用者相比，抗血小板药物使用者的MB过量较少（OR，1.7; 95％CI，1.3-2.3; P <0.001），但对于IS / TIA的抗血小板药物使用者，结果相似（OR，1.4; 95％ CI，1.2-1.7; P ＜0.001; P差＝ 0.25）。在针对768名抗血栓形成药物使用者的汇总随访数据中，基线时存在MB与随后发生ICH的风险显着增加相关（OR，12.1; 95％CI，3.4-42.5; P <0.001）。结论：与其他组相比，ICH的华法林使用者中MB过多表明MB增加了华法林相关ICH的风险。有限的前瞻性数据证实了这些发现，但迫切需要进行更大的前瞻性研究。
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