Cerebral microbleeds (CMBs) are found in up to one-third of patients with ischemic stroke.1 Because of their hemorrhagic histopathological substrate, they have been historically associated with a risk of intracerebral hemorrhage (ICH). This has led to concerns about the safety of anticoagulation use in patients with CMBs even in the context of high risk of recurrent ischemic stroke, such as in atrial fibrillation. However, growing evidence suggests that CMBs are not only markers of bleeding propensity but also markers of future ischemic events. To further evaluate both types of risks, an assessment of the number and anatomic distribution of CMBs might be helpful.2 Unfortunately, available data are based on observational studies with inherent bias and, to our knowledge, no randomized clinical trial to date has clearly determined the net clinical benefit of anticoagulation in patients with CMBs and a high risk of thromboembolic events.
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Puy L, Cordonnier C. Cerebral Microbleeds and Antithrombotic Treatments—Stop Worrying About Bleeding. JAMA Neurol. 2021;78(1):9–10. doi:10.1001/jamaneurol.2020.3847
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