RISK OF CEREBRAL MICROBLEEDS AND ICH IN STROKE ISCHEMIC AND TIA PATIENTS ASSOCIATED WITH THE USE OF ANTIPLATELET MEDICATIONS: A SYSTEMATIC REVIEW

Authors

  • Farah Shafira Zulkarnain Faculty of Medicine, General Achmad Yani University
  • Andhira Riyan Ashori Hidayat Faculty of Medicine, General Achmad Yani University

DOI:

https://doi.org/10.53555/nnmhs.v9i2.1548

Keywords:

Antiplatelet, Cerebral Microbleeds, ICH, Stroke Ischemic, TIA

Abstract

Stroke is conventionally described as a neurological dysfunction linked with acute focal central nervous system (CNS) injury resulting from vascular sources. Ischemic stroke is a neurological impairment resulting from arterial blockage. Ischemic strokes are the most prevalent type of stroke. Antiplatelet therapy is essential to the treatment of noncardioembolic ischemic stroke and transient ischemic attack (TIA) in order to alleviate the severity of this burden. The evidence supports aspirin, aspirin-dipyridamole, clopidogrel, and ticagrelor, four antiplatelet medicines. These antiplatelets were selected as the most effective since they have been the subject of decisive clinical trials and are the most frequently referenced in clinical practice guidelines. The low incidence of intracranial hemorrhage (ICH) could be attributed to the fact that the majority of patients took aspirin instead of oral anticoagulants. The incidence of ICH was equivalent to that seen in trials that included antiplatelet drug participants. The study was unable to rule out the potential that the presence of microbleeds in patients on oral anticoagulants suggests an increased risk of ICH. The use of antiplatelet medicines enhanced the risk of strictly lobar MBs and the rate of intracerebral hemorrhage in CMB patients. 

References

Collaborators G. S, Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, et al. Global, regional, and national burden of stroke and its risk factors, 1990–2019: A systematic analysis for the global burden of disease study 2019. Lancet Neurol.

2021;20:795–820.

Feigin VL, Norrving B, Mensah GA. Global Burden of Stroke. Circ Res. 2017;120(3):439–48.

Del Brutto VJ, Chaturvedi S, Diener H-C, Romano JG, Sacco RL. Antithrombotic therapy to prevent recurrent strokes in ischemic cerebrovascular disease: JACC scientific expert panel. J Am Coll Cardiol. 2019;74(6):786–803.

Kwok CS, Shoamanesh A, Copley HC, Myint PK, Loke YK, Benavente OR.

Efficacy of antiplatelet therapy in secondary prevention following lacunar stroke: pooled analysis of randomized trials. Stroke. 2015;46(4):1014–23.

Shah J, Liu S, Yu W. Contemporary antiplatelet therapy for secondary stroke prevention: a narrative review of current literature and guidelines. Stroke Vasc Neurol. 2022;7(5).

Frei SP, Burmeister DB, Coil JF. Frequency of serious outcomes in patients with hypertension as a chief complaint in the emergency department. J Am Osteopath Assoc. 2013 Sep;113(9):664–8.

Kheiri B, Osman M, Abdalla A, Haykal T, Swaid B, Ahmed S, et al. Clopidogrel and aspirin after ischemic stroke or transient ischemic attack: an updated systematic review and meta-analysis of randomized clinical trials. J Thromb Thrombolysis. 2019;47:233–47.

Naqvi IA, Kamal AK, Rehman H. Multiple versus fewer antiplatelet agents for preventing early recurrence after ischaemic stroke or transient ischaemic attack. Cochrane Database Syst Rev. 2020;(8).

Meng N, Zhang W, Su Y, Ye Z, Qin C. Antiplatelet therapy may be safe in ischemic stroke patients with cerebral microbleed. J Int Med Res. 2020 Aug;48(8):300060520949396.

Kwa VIH, Algra A, Brundel M, Bouvy W, Kappelle LJ. Microbleeds as a predictor of intracerebral haemorrhage and ischaemic stroke after a TIA or minor ischaemic stroke: a cohort study. BMJ Open. 2013 May;3(5).

Jung NY, Cho J. Clinical effects of restarting antiplatelet therapy in patients with intracerebral hemorrhage. Clin Neurol Neurosurg [Internet]. 2022;220:107361.

Available from:

https://www.sciencedirect.com/science/article/pii/S0303846722002426

Campbell BC V, De Silva DA, Macleod MR, Coutts SB, Schwamm LH, Davis SM, et al. Ischaemic stroke. Nat Rev Dis Prim [Internet]. 2019;5(1):70. Available from: https://doi.org/10.1038/s41572-019-0118-8

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. stroke. 2018;49(3):e46–99.

Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke.

2014;45(7):2160–236.

Chugh C. Acute Ischemic Stroke: Management Approach. Indian J Crit care Med peer-reviewed, Off Publ Indian Soc Crit Care Med. 2019 Jun;23(Suppl 2):S140–

6.

Lee H-L, Kim J-T, Lee JS, Park M-S, Choi K-H, Cho K-H, et al. Comparative Effectiveness of Dual Antiplatelet Therapy With Aspirin and Clopidogrel Versus Aspirin Monotherapy in Mild-to-Moderate Acute Ischemic Stroke According to

the Risk of Recurrent Stroke. Circ Cardiovasc Qual Outcomes [Internet]. 2020 Nov

1;13(11):e006474. Available from:

https://doi.org/10.1161/CIRCOUTCOMES.119.006474

Wilson D, Charidimou A, Ambler G, Fox Z V, Gregoire S, Rayson P, et al. Recurrent stroke risk and cerebral microbleed burden in ischemic stroke and TIA: a meta-analysis. Neurology. 2016;87(14):1501–10.

Soo YOY, Siu DYW, Abrigo J, Yu S, Ng N, Ahuja AT, et al. Risk of intracerebral hemorrhage in patients with cerebral microbleeds undergoing endovascular intervention. Stroke. 2012;43(6):1532–6.

Lau KK, Lovelock CE, Li L, Simoni M, Gutnikov S, Küker W, et al. Antiplatelet Treatment After Transient Ischemic Attack and Ischemic Stroke in Patients With Cerebral Microbleeds in 2 Large Cohorts and an Updated Systematic Review. Stroke. 2018 Jun;49(6):1434–42.

van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010 Feb;9(2):167–76.

Tzourio C, Arima H, Harrap S, Anderson C, Godin O, Woodward M, et al. APOE genotype, ethnicity, and the risk of cerebral hemorrhage. Neurology. 2008;70(16):1322–8.

Ku S-K, Bae J-S. Antiplatelet and antithrombotic activities of purpurogallin in vitro and in vivo. BMB Rep. 2014;47(7):376.

Naka H, Nomura E, Kitamura J, Imamura E, Wakabayashi S, Matsumoto M. Antiplatelet therapy as a risk factor for microbleeds in intracerebral hemorrhage patients: analysis using specific antiplatelet agents. J Stroke Cerebrovasc Dis. 2013;22(6):834–40.

Darweesh SKL, Leening MJG, Akoudad S, Loth DW, Hofman A, Arfan Ikram M, et al. Clopidogrel use is associated with an increased prevalence of cerebral microbleeds in a stroke?free population: The Rotterdam study. J Am Heart Assoc. 2013;2(5):e000359.

Committee CS. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348(9038):1329–39.

Shinohara Y, Katayama Y, Uchiyama S, Yamaguchi T, Handa S, Matsuoka K, et al. Cilostazol for prevention of secondary stroke (CSPS 2): an aspirin-controlled, double-blind, randomised non-inferiority trial. Lancet Neurol. 2010;9(10):959–68. 27. Yamashiro K, Tanaka R, Okuma Y, Ueno Y, Tanaka Y, Hattori N, et al. Associations of durations of antiplatelet use and vascular risk factors with the presence of cerebral microbleeds. J stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2014 Mar;23(3):433–40.

Kim CK, Kwon HT, Kwon H-M. No significant association of aspirin use with cerebral microbleeds in the asymptomatic elderly. J Neurol Sci. 2012;319(1– 2):56–8.

Carino A, De Rosa S, Sorrentino S, Polimeni A, Sabatino J, Caiazzo G, et al. Modulation of Circulating MicroRNAs Levels during the Switch from Clopidogrel to Ticagrelor. Biomed Res Int. 2016;2016:3968206.

Shuaib A, Akhtar N, Kamran S, Camicioli R. Management of Cerebral

Microbleeds in Clinical Practice. Transl Stroke Res [Internet]. 2019;10(5):449–57. Available from: https://doi.org/10.1007/s12975-018-0678-z

Downloads

Published

2023-02-21

How to Cite

Shafira Zulkarnain, F. ., & Riyan Ashori Hidayat , A. . (2023). RISK OF CEREBRAL MICROBLEEDS AND ICH IN STROKE ISCHEMIC AND TIA PATIENTS ASSOCIATED WITH THE USE OF ANTIPLATELET MEDICATIONS: A SYSTEMATIC REVIEW . Journal of Advanced Research in Medical and Health Science (ISSN 2208-2425), 9(2), 48-54. https://doi.org/10.53555/nnmhs.v9i2.1548