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. 2021 Jul;52(7):2347-2355.
doi: 10.1161/STROKEAHA.120.031515. Epub 2021 May 10.

Cerebral Microbleeds: Relationship to Antithrombotic Medications

Jonathan Graff-Radford  1 , Timothy Lesnick  2 , Alejandro A Rabinstein  1 , Jeffrey L Gunter  3 , Scott A Przybelski  2 , Peter A Noseworthy  4 , Gregory M Preboske  3 , Michelle M Mielke  1   2 , Val J Lowe  3 , David S Knopman  1 , Ronald C Petersen  1 , Walter K Kremers  2 , Clifford R Jack Jr  3 , Prashanthi Vemuri  3 , Kejal Kantarci  3
Affiliations

Cerebral Microbleeds: Relationship to Antithrombotic Medications

Jonathan Graff-Radford et al. Stroke. 2021 Jul.

Abstract

Background and purpose: Cerebral microbleeds (CMBs) are represented by small areas of hemosiderin deposition, detected on brain magnetic resonance imaging (MRI), and found in ≈23% of the cognitively normal population over age of 60 years. CMBs predict risk of hemorrhagic and ischemic stroke. They correlate with increased cardiovascular mortality. In this article, we sought to determine in a population-based study whether antithrombotic medications correlate with CMBs and, if present, whether the association was direct or mediated by another variable.

Methods: The study consisted of 1253 participants from the population-based Mayo Clinic Study of Aging who underwent T2* gradient-recalled echo magnetic resonance imaging. We tested the relationship between antithrombotic medications and CMB presence and location, using multivariable logistic-regression models. Ordinal logistic models tested the relationship between antithrombotics and CMB frequency. Using structural equation models, we assessed the effect of antithrombotic medications on presence/absence of CMBs and count of CMBs in the CMB-positive group, after considering the effects of age, sex, vascular risk factors, amyloid load by positron emission tomography, and apoE.

Results: Two hundred ninety-five participants (26.3%) had CMBs. Among 678 participants taking only antiplatelet medications, 185 (27.3%) had CMBs. Among 95 participants taking only an anticoagulant, 43 (45.3%) had CMBs. Among 44 participants taking an anticoagulant and antiplatelet therapy, 21 (48.8%) had CMBs. Anticoagulants correlated with the presence and frequency of CMBs, whereas antiplatelet agents were not. Structural equation models showed that predictors for presence/absence of CMBs included older age at magnetic resonance imaging, male sex, and anticoagulant use. Predictors of CMB count in the CMB-positive group were male sex and amyloid load.

Conclusions: Anticoagulant use correlated with presence of CMBs in the general population. Amyloid positron emission tomography correlated with the count of CMBs in the CMB-positive group.

Keywords: anticoagulants; hemorrhage; ischemic stroke; magnetic resonance imaging; positron emission tomography.

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Figures

Figure 1:
Figure 1:. Full SEM model for prediction of CMBs.
This diagram presents the variables under consideration and the maximum number of associations (arrows) we could find in this specified structure. Variables can affect other variables to their right, as denoted by the arrows. Pruning removes non-significant arrows from this structure to produce parsimonious models.
Figure 2:
Figure 2:
A) Pruned SEM for predicting CMB risk Arrows show significant associations (p<0.05). P-values are found in Table 4. The numbers on the arrows are coefficients (standard errors). B) Pruned SEM for predicting deep CMB risk
Figure 2:
Figure 2:
A) Pruned SEM for predicting CMB risk Arrows show significant associations (p<0.05). P-values are found in Table 4. The numbers on the arrows are coefficients (standard errors). B) Pruned SEM for predicting deep CMB risk
See this image and copyright information in PMC

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