[Skip to Navigation]
Views 6,350
Citations 0
October 19, 2020

Cerebral Microbleeds and Antithrombotic Treatments—Stop Worrying About Bleeding

Author Affiliations
  • 1Université Lille, Inserm, CHU Lille, U1172—LilNCog—Lille Neuroscience & Cognition, F-59000 Lille, France
JAMA Neurol. 2021;78(1):9-10. doi:10.1001/jamaneurol.2020.3847

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.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words