Best, Jonathan;
Jesuthasan, Aaron;
Werring, David;
(2022)
Cerebral small vessel disease and intracranial bleeding risk: prognostic and practical significance.
International Journal of Stroke
10.1177/17474930221106014.
(In press).
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Abstract
Balancing the risks of recurrent ischaemia and antithrombotic-associated bleeding, particularly intracranial haemorrhage (ICH), is a key challenge in the secondary prevention of ischaemic stroke and transient ischaemic attack. In hyperacute ischaemic stroke, the use of acute reperfusion therapies is determined by the balance of anticipated benefit and the risk of ICH. Cerebral small vessel disease (CSVD) causes most spontaneous ICH. Here, we review the evidence linking neuroimaging markers of CSVD to antithrombotic and thrombolytic-associated ICH, with emphasis on cerebral microbleeds (CMB). We discuss their role in the prediction of ICH, and practical implications for clinical decision making. Although current observational data suggests CMB presence should not preclude antithrombotic therapy in patients with ischaemic stroke or TIA, they are useful for improving ICH risk prediction with potential relevance for determining the optimal secondary prevention strategy, including the use of left atrial appendage occlusion. Following ICH, recommencing antiplatelets is probably safe in most patients, while the inconclusive results of recent randomised controlled trials of anticoagulant use makes recruitment to ongoing trials (including those testing left atrial appendage occlusion) in this area a high priority. Concern regarding CSVD and ICH risk after hyperacute stroke treatment appears to be unjustified most patients, though some uncertainty remains regarding patients with very high CMB burden and other risk factors for ICH. We encourage careful phenotyping for underlying CSVD in future trials, with potential to enhance precision medicine in stroke.
| Type: | Article |
|---|---|
| Title: | Cerebral small vessel disease and intracranial bleeding risk: prognostic and practical significance |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1177/17474930221106014 |
| Publisher version: | https://doi.org/10.1177%2F17474930221106014 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions. |
| Keywords: | Brain microbleeds, Cerebral hemorrhage, Hemorrhage, Intracerebral hemorrahage, MRI, Prevention |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Brain Repair and Rehabilitation |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10150233 |
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