Cerebral microbleeds are a risk factor for warfarin-related intracerebral hemorrhage

Neurology. 2009 Jan 13;72(2):171-6. doi: 10.1212/01.wnl.0000339060.11702.dd.

Abstract

Background: Cerebral microbleeds are known to be indicative of bleeding-prone microangiopathy and may predict incident intracerebral hemorrhage (ICH). In this study, we investigated whether microbleeds are associated with the incidence of warfarin-related ICH.

Methods: Twenty-four patients with ICH while on outpatient treatment with warfarin were selected from a consecutive cohort. Control, warfarin-using subjects with no history of ICH were randomly selected during the same time period (n = 48). We compared demographic factors, vascular risk factors, laboratory findings, and radiologic findings including microbleeds between the groups.

Result: There were more cases of patients with microbleeds in the ICH than control group (79.2% vs 22.9%: p < 0.001), and the number of microbleeds was much higher for the ICH group (9.0 +/- 26.8 vs 0.5 +/- 1.03: p < 0.001). Moreover, the number of microbleeds was significantly correlated with the presence of warfarin-related ICH (r = 0.299; p < 0.001). Conditional logistic regression analysis showed that increased prothrombin time and the presence of microbleeds were independently related to the incidence of warfarin-related ICH (microbleeds: adjusted OR, 83.12).

Conclusion: This study suggests that underlying microbleeds are independently associated with an incidence of warfarin-related intracerebral hemorrhage. Future research should focus on elucidating the risks and benefits of warfarin medication in patients with microbleeds.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anticoagulants / adverse effects*
  • Arterioles / drug effects
  • Arterioles / pathology
  • Arterioles / physiopathology
  • Brain / blood supply
  • Brain / pathology
  • Cerebral Arteries / drug effects*
  • Cerebral Arteries / pathology
  • Cerebral Arteries / physiopathology
  • Cerebral Hemorrhage / chemically induced*
  • Cerebral Hemorrhage / epidemiology
  • Cerebral Hemorrhage / physiopathology
  • Female
  • Humans
  • Incidence
  • Intracranial Thrombosis / drug therapy*
  • Male
  • Microcirculation / drug effects
  • Microcirculation / physiology
  • Middle Aged
  • Prothrombin Time
  • Risk Factors
  • Warfarin / adverse effects*

Substances

  • Anticoagulants
  • Warfarin