Effect Of Antithrombotic Therapy For Ischemic Stroke/TIA On Cerebral Microbleeds

Objective:The number and distribution of cerebral microbleeds(CMBs)were dynamically observed by magnetic sensitive weighted imaging(SWI),and the effect of CMBs on the risk-benefit ratio of antithrombotic drugs in the assessment of acute stage and secondary prevention of ischemic stroke / TIA was studied.Methods:Patients with definite diagnosis of acute cerebral infarction and transient ischemic attack from September 2017 to March 2018 were selected for study.The enrolled patients were divided into two groups according to the presence or absence of CMBs,and the risk factors of CMBs were analyzed.According to the guidelines,the patients were given long-term antiplatelet therapy,followed up for 20 months in an outpatient or telephone setting to observe the dynamic changes of CMBs and endpoint events.We used statistical methods to analyze the influencing factors of endpoint events and explore the relationship between CMBs and endpoint events.Results:1.A total of 53 patients with acute cerebral infarction and transient ischemic attack were included in this study,including 32 patients with CMBs and 21 patients without CMBs.There were statistically significant differences in age,hypertension and renal function between the two groups(P<0.05).Multivariate logistic analysis showed that age(with CMBs vs without CMBs: 64.2±7.4 vs 54.8±8.5)and hypertension(with CMBs vs without CMBs: 87.5% vs 52.4%)were the independent risk factors of CMBs.2.After a follow-up of 12.6±9.4 months,we found that the subsequent cerebral hemorrhage was significantly correlated with CMBs:6 with CMBs(18.8%)vs 0 without CMBs(0%),P=0.035,OR=1.23,95% CI: 1.042-1.454;there was no significant correlation between recurrent cerebral infarction and CMBs: 7 with CMBs(21.9%)vs 6without CMBs(28.6%),P=0.579,OR=0.70,95% CI: 0.198-2.479.There was no significant difference of recurrent cerebral infarction between the two groups.The risk of cerebral hemorrhage increased with the number of CMBs: 0.0%(0 CMBs),11.11%(1 CMBs),17.65%(2-4 CMBs)and33.33%(more than 5 CMBs).The trend of recurrent cerebral infarction(24.5%)was higher than that of cerebral hemorrhage(11.3%);when CMBs?5,the risk of cerebral hemorrhage(33.33%)was higher than that of recurrent cerebral infarction(16.67%).3.Cox proportional-hazards analysis performed with cerebralhemorrhage as the end point showed that age(P=0.027),CMBs(P=0.033)and CMBs?5(P=0.039)were independent risk factors for subsequent cerebral hemorrhage.Conclusion:1.CMBs,as a reflection of the degree of cerebrovascular injury,is an independent risk factor for subsequent cerebral hemorrhage.2.For patients with low CMBs load,long-term antiplate therapy is safe and necessary;however,for patients with high CMBs load,the risks of antiplate therapy may outweight the benefits.3.CMBs is expected to be one of the indicators to monitor the safety of secondary stroke prevention treatment and evaluate the prognosis.