Article Text

Microbleeds as a predictor of intracerebral haemorrhage and ischaemic stroke after a TIA or minor ischaemic stroke: a cohort study
  1. Vincent I H Kwa1,
  2. Ale Algra2,3,
  3. Manon Brundel2,
  4. Willem Bouvy2,
  5. L Jaap Kappelle2,
  6. on behalf of the MICRO Study Group
  1. 1Department of Neurology, Onze Lieve Vrouwe Gasthuis,Slotervaart Hospital, Amsterdam, The Netherlands
  2. 2Department of Neurology and Neurosurgery, UMC Utrecht Stroke Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
  3. 3Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands
  1. Correspondence to Dr Vincent I H Kwa; v.i.h.kwa{at}


Objectives We examined whether patients with cerebral microbleeds on MRI, who started and continued antithrombotic medication for years, have an increased risk of symptomatic intracerebral haemorrhage (ICH).

Design Prospective cohort study.

Settings Multicentre outpatient clinics in the Netherlands.

Participants We followed 397 patients with newly diagnosed transient ischaemic attack (TIA) or minor ischaemic stroke receiving anticoagulants or antiplatelet drugs. 58% were men. The mean age was 65.3 years. 395 (99%) patients were white Europeans. MRI including a T2*-weighted gradient echo was performed within 3 months after start of medication. 48 (12%) patients had one or more microbleeds. They were followed every 6 months by telephone for a mean of 3.8 years.

Primary and secondary outcome measures Primary outcome was a symptomatic ICH. Secondary outcome were all strokes, ischaemic stroke, myocardial infarct, death from all vascular causes, death from non-vascular causes and death from all causes.

Results Five patients (1%) suffered from a symptomatic ICH. One ICH occurred in a patient with microbleeds at baseline (adjusted HR 2.6, 95% CI 0.3 to 27). The incidence of all strokes during follow-up was higher in patients with than without microbleeds (adjusted HR 2.3, 95% CI 1.0 to 5.3), with a dose–response relationship. The incidences of ischaemic stroke, vascular death, non-vascular death and death of all causes were higher in patients with microbleeds, but not statistically significant.

Conclusions In our cohort of patients using antithrombotic drugs after a TIA or minor ischaemic stroke, we found that microbleeds on MRI are associated with an increased risk of future stroke in general, but we did not find an increased risk of symptomatic ICH.

  • Oral Medicine
  • Stroke Medicine
  • Vascular Medicine

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