Background and Purpose: Cerebral microbleeds (CMBs) are known to be potential risk
factors for intracerebral hemorrhage (ICH), but there is controversy on the relationship between
CMBs and hemorrhagic transformation (HT) after ischemic stroke. Besides, the question regarding
whether the relationship between CMBs and HT can be affected by antithrombotic drugs in acute
stage of ischemic stroke has not yet reached a consensus.
Methods: 174 acute ischemic stroke patients with atrial fibrillation (AF) and/or rheumatic heart
disease (RHD) were prospectively and consecutively enrolled in the study, of which 160 patients
(mean 68.09 ±12.59 years) were finally included in the final analysis (West China Hospital, Sichuan
University, n=125; People’s Hospital of Deyang City, n=35).We assessed the presence, location and
number of CMBs by using susceptibility-weighted imaging (SWI) within 7 days after admission,
and the incidence of hemorrhagic transformation was evaluated by magnetic resonance
imaging(MRI) during hospitalization. The univariate and multivariate analyses were used to analyze
the relationship between CMBs and HT.
Results: CMBs were detected in 90 patients (56.3%). HT was found in 62 (38.8%) patients, among
which 43 were hemorrhagic infarction (HI) and 19 were parenchymal haemorrhage (PH). The
presence of CMBs was not significantly different among different HT subtypes (no HT, HI and PH;
59.2%, 51.2%, versus 52.6%, P=0.64). There was no relationship between the number/location of
CMBs and hemorrhagic transformation subtypes (P=0.38). In the 2 subgroups of patients treated
with anticoagulants and antiplatelets after admission, the incidence of HT was not significantly
different between patients with and without CMBs (anticoagulants, 13.3% versus 18.2%, P=0.71;
antiplatelets, 29.2% versus 40.3%, P= 0.21).
Conclusion: The present study suggests that CMBs do not predict the presence of hemorrhagic
transformation in acute ischemic stroke patients with AF and/or RHD. The results were not affected
by anticoagulant or antiplatelet agents used in acute stage of ischemic stroke.