Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK.
J Neurol Neurosurg Psychiatry. 2010 Jun;81(6):679-84. doi: 10.1136/jnnp.2009.198994.
Intracerebral haemorrhage (ICH) is an uncommon but devastating complication of regular antiplatelet use: identifying high-risk patients before treatment could potentially reduce this hazard. Brain microbleeds on gradient-recalled echo (GRE) T2*-weighted MRI are considered a biomarker for bleeding-prone small-vessel diseases. The authors hypothesised that microbleeds are a risk factor for antiplatelet-related ICH, and investigated this in a hospital-based matched case-control study.
Cases of spontaneous ICH were ascertained, using overlapping methods, from a prospective database of 1017 consecutive unselected patients referred to our stroke unit and associated clinics. For each case of antiplatelet-related ICH, two controls matched for age, sex and hypertension without history of ICH on antiplatelet therapy were selected. Microbleeds were identified by a trained observer blinded to clinical details.
Microbleeds were more frequent in antiplatelet users with ICH than in matched antiplatelet users without ICH (13/16 (81%) vs 6/32 (19%), p=0.004) and patients with non-antiplatelet-related ICH (13/16 (81%) vs 15/33 (45%), p=0.03). The frequency of lobar microbleeds was 11/16 (69%) in antiplatelet-related ICH versus 11/33 (33%) in non antiplatelet-related ICH (p=0.032). Microbleeds were more numerous in antiplatelet users with ICH compared with controls (p=0.016). The number of microbleeds was associated with the risk of antiplatelet-related ICH (adjusted OR 1.33 per additional microbleed, 95% CI 1.06 to 1.66, p=0.013).
Brain microbleeds are associated with antiplatelet-related ICH. In patients with a large number of lobar microbleeds, the risk of ICH could outweigh the benefits of antiplatelet therapy. Larger prospective studies to investigate the prognostic significance of microbleeds in regular antiplatelet users are warranted.
脑内出血（ICH）是常规抗血小板治疗的一种罕见但严重的并发症：在治疗前识别高危患者可能会降低这种风险。梯度回波（GRE）T2*-加权 MRI 上的脑微出血被认为是出血性小血管疾病的生物标志物。作者假设微出血是抗血小板相关 ICH 的危险因素，并在一项基于医院的匹配病例对照研究中对此进行了研究。
使用重叠方法，从我们的卒中病房和相关诊所连续收治的 1017 例未经选择的患者的前瞻性数据库中确定自发性 ICH 病例。对于每例抗血小板相关 ICH 病例，选择年龄、性别和高血压相匹配且无抗血小板治疗史的 ICH 对照者 2 例。微出血由一名对临床细节不知情的训练有素的观察者确定。
与匹配的抗血小板治疗且无 ICH 的患者（6/32，19%）相比，抗血小板治疗且有 ICH 的患者（13/16，81%）微出血更常见（p=0.004），与非抗血小板治疗相关的 ICH 患者（13/16，81%）相比也更常见（p=0.03）。抗血小板相关 ICH 患者中脑叶微出血的频率为 11/16（69%），而非抗血小板相关 ICH 患者中为 11/33（33%）（p=0.032）。与对照组相比，抗血小板治疗且有 ICH 的患者微出血更多（p=0.016）。微出血的数量与抗血小板相关 ICH 的风险相关（校正 OR 每增加一个微出血增加 1.33，95%CI 1.06 至 1.66，p=0.013）。
脑微出血与抗血小板相关 ICH 相关。在有大量脑叶微出血的患者中，ICH 的风险可能超过抗血小板治疗的益处。需要进行更大规模的前瞻性研究来研究微出血在常规抗血小板治疗患者中的预后意义。
