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Chapter 19 - Cerebral microbleeds and antithrombotictreatment

from Section 3 - Microbleeds in relation to specific populations, diseases and neurological symptoms

Published online by Cambridge University Press:  05 July 2011

David J. Werring
Affiliation:
Institute of Neurology, London
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Summary

Cerebral microbleeds (CMBs), detected by MRI gradient-recalled echo (GRE) sequences, are increasingly recognized as a potential radiological predictor for massive symptomatic intracerebral hemorrhage (ICH). The possible association between antithrombotic drug exposure and presence of CMBs is potentially confounded by the indications for which the drugs are prescribed. As CMBs may be related to the presence of cardiovascular and cerebrovascular diseases in general, antithrombotic drugs may be more often prescribed to persons with an increased risk of developing CMBs unrelated to the use of antithrombotic agents. In non-cardioembolic ischemic stroke, antiplatelet agents remain the mainstay of treatment for secondary stroke prevention. In general, aspirin is considered as a safe antiplatelet agent for ischemic stroke, carrying only a 1% risk of symptomatic ICH. Anticoagulation with warfarin remains the most effective prevention for cardioembolic stroke related to atrial fibrillation; in randomized clinical trials, warfarin reduced the relative risk of stroke by 60-70%.
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Cerebral Microbleeds
Pathophysiology to Clinical Practice
, pp. 165 - 172
Publisher: Cambridge University Press
Print publication year: 2011

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