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Cerebral Microbleeds and Antithrombotic Treatments—Stop Worrying About Bleeding

Cerebral Microbleeds and Antithrombotic Treatments—Stop Worrying About Bleeding Opinion EDITORIAL Cerebral Microbleeds and Antithrombotic Treatments— Stop Worrying About Bleeding Laurent Puy, MD; Charlotte Cordonnier, MD, PhD Cerebral microbleeds (CMBs) are found in up to one-third of brain magnetic resonance imaging was performed before ran- patients with ischemic stroke. Because of their hemorrhagic domization, so the proportion of patients with CMBs should roughly be the same in the 2 treatment arms. Nevertheless, we histopathological substrate, they have been historically asso- ciated with a risk of intracerebral hemorrhage (ICH). This should consider a possible selection bias: clinicians are less has led to concerns about the likely to include patients who they consider at high risk of fu- safety of anticoagulation use ture intracranial bleeding, so they offer participation in the Related article page 11 in patients with CMBs even in study to patients with no or few CMBs. This may partly ex- the context of high risk of recurrent ischemic stroke, such as plain why a low proportion of patients had CMBs at baseline: in atrial fibrillation. However, growing evidence suggests that 395 of 3699 patients (11%) had at least 1 CMB, whereas the CMBs are not only markers of bleeding propensity but also prevalence of CMBs is around http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Neurology American Medical Association

Cerebral Microbleeds and Antithrombotic Treatments—Stop Worrying About Bleeding

JAMA Neurology , Volume 78 (1) – Jan 19, 2021

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Publisher
American Medical Association
Copyright
Copyright 2020 American Medical Association. All Rights Reserved.
ISSN
2168-6149
eISSN
2168-6157
DOI
10.1001/jamaneurol.2020.3847
Publisher site
See Article on Publisher Site

Abstract

Opinion EDITORIAL Cerebral Microbleeds and Antithrombotic Treatments— Stop Worrying About Bleeding Laurent Puy, MD; Charlotte Cordonnier, MD, PhD Cerebral microbleeds (CMBs) are found in up to one-third of brain magnetic resonance imaging was performed before ran- patients with ischemic stroke. Because of their hemorrhagic domization, so the proportion of patients with CMBs should roughly be the same in the 2 treatment arms. Nevertheless, we histopathological substrate, they have been historically asso- ciated with a risk of intracerebral hemorrhage (ICH). This should consider a possible selection bias: clinicians are less has led to concerns about the likely to include patients who they consider at high risk of fu- safety of anticoagulation use ture intracranial bleeding, so they offer participation in the Related article page 11 in patients with CMBs even in study to patients with no or few CMBs. This may partly ex- the context of high risk of recurrent ischemic stroke, such as plain why a low proportion of patients had CMBs at baseline: in atrial fibrillation. However, growing evidence suggests that 395 of 3699 patients (11%) had at least 1 CMB, whereas the CMBs are not only markers of bleeding propensity but also prevalence of CMBs is around

Journal

JAMA NeurologyAmerican Medical Association

Published: Jan 19, 2021

References