Aktuelle Neurologie 2008; 35 - P773
DOI: 10.1055/s-0028-1087027

Detection of cerebral microbleeds in patients treated with oral anticoagulants

H Wersching 1, C Stehling 1, P Kirchhof 1, W Heindel 1, S Knecht 1
  • 1Münster

Background and aims: Cerebral microbleeds (CMBs) are perivascular hemosiderin deposits frequently detected in patients with intracerebral hemorrhage and ischemic cerebral infarction. If proven a marker for bleeding-prone microangiopathy, CMBs might be of prognostic value in the therapeutic decision of anticoagulation. The purpose of our study was to evaluate the appearance of CMBs using Gradient echo T2*-weighted MRI in persons treated with oral anticoagulants without symptomatic cerebrovascular disease.

Methods: We used data of 494 elderly community-dwelling individuals (mean age 62 years, 247 male) without and with atrial fibrillation (SEARCH-Health study). All subjects underwent clinical examination, neuropsychological testing and 3.0 T MRI. CMBs were defined as focal areas of low signal intensity on T2*MRI of less than 10mm in diameter. White matter hyperintensities were calculated semiquantitatively.

Results: Forty-nine individuals currently used oral anticoagulants. CMBs were found in 10 of 49 individuals with anticoagulation, and in 38 of 407 individuals without anticoagulation (p<.05). However, beside treatment with anticoagulants, advanced age and the presence of cardiovascular disease (arterial hypertension, atrial fibrillation, ischemic heart disease) was significantly more common in subjects with CMBs than in those without. Adjusting for these factors in logistic regression analysis showed that only arterial hypertension and ischemic heart disease were significant and independent predictors of CMBs. Furthermore subjects with CMBs had significantly more white matter intensities.

Conclusion: Cerebral microbleeds are more than twice as common in patients on oral anticoagulation therapy compared to those without such a therapy. However, the effect is attributable to associated cardiovascular risk factors rather than the anticoagulation itself. This finding is further supported by the fact, that the manifestation of CMBs in our study was highly correlated with the degree of white matter disease.