title: Cerebral microbleeds on T2*-weighted images and hemorrhagic transformation after antithrombotic therapies for ischemic stroke.
abstract: To assess the predictive value of cerebral microbleeds (CMBs) on gradient-echo T2*-weighted magnetic resonance imaging for hemorrhagic transformation (HT) after antithrombotic therapy for an acute ischemic stroke, we prospectively examined the relationship between CMBs on T2*-weighted images before the start of therapy and the appearance of HT in a series of patients treated with antithrombotic therapies. The subjects were consecutive acute ischemic stroke patients admitted to Tokai University Hospital (187 subjects, mean age±SD: 74±11 years). The prevalence of CMBs was not significantly different between the subjects with and without HT on computed tomography (CT) (19% versus 36%, P=.081). In both the subgroup of patients treated with anticoagulants and the subgroup treated with antiplatelets, the prevalence of HT was not significantly different between the subjects with and without CMBs (anticoagulants, 9% versus 21%, P=.161; antiplatelets, 0% versus 9%, P=.542). The odds ratios (ORs) of increasing the National Institutes of Health Stroke Scale score (1.14, 95% confidence interval [CI]: 1.04-1.26, P=.005) and decreasing the Alberta Stroke Program Early CT Score on diffusion-weighted images (ASPECTS-DWI) (1.32, 95% CI: 1.10-1.59, P=.003) were significantly increased for the appearance of HT, but the OR of CMBs (.35, 95% CI: .09-1.41, P=.140) was not significantly increased for the appearance of HT. In conclusion, the severity of neurological deficits and the ASPECTS-DWI are closely correlated to the development of HT related to anticoagulants/antiplatelets but not to CMBs on T2*-weighted images.
authors.affiliation: Department of Neurology, Tokai University School of Medicine, Kanagawa, Japan. Electronic address: kawasi29@is.icc.u-tokai.ac.jp.
authors.forename: Wakoh
authors.initials: W
authors.lastname: Takahashi
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Moriya
authors.forename: Atsushi
authors.initials: A
authors.lastname: Mizuma
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Uesugi
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Ohnuki
authors.forename: Shunya
authors.initials: S
authors.lastname: Takizawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D002533:Cerebral Angiography / Q000379:methods; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D016009:Chi-Square Distribution; D038524:Diffusion Magnetic Resonance Imaging; D004185:Disability Evaluation; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006785:Hospitals, University; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors
keywords: Ischemic stroke; anticoagulant; antiplatelet agent; gradient-echo T2*-weighted sequences; hemorrhagic transformation; microbleeds