Antiplatelet therapy and future intracerebral hemorrhage in hemodialysis patients with cerebral microbleeds

•Brain MRI was performed in 179 HD patients with no history of cerebrovascular events.•CMBs were detected in 45 patients and antiplatelet drugs were used in 66 patients.•In the median follow-up period of 5.2 years, ICH occurred in 12 patients.•The effect of antiplatelet therapy for ICH was modified...

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Bibliographic Details
Published in:Journal of clinical neuroscience 2021-08, Vol.90, p.155-160
Main Authors: Naganuma, Toshihide, Kabata, Daijiro, Takemoto, Yoshiaki, Uchida, Junji, Shintani, Ayumi
Format: Article
Language:English
Subjects:
Antiplatelet therapy
Cerebral microbleeds
Dialysis
Intracerebral hemorrhage
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Summary:•Brain MRI was performed in 179 HD patients with no history of cerebrovascular events.•CMBs were detected in 45 patients and antiplatelet drugs were used in 66 patients.•In the median follow-up period of 5.2 years, ICH occurred in 12 patients.•The effect of antiplatelet therapy for ICH was modified by CMBs at baseline.•Antiplatelet therapy did not increase the risk for ICH in HD patients with CMBs. The use of antiplatelet drugs is thought to increase the risk for intracerebral hemorrhage (ICH) in patients with cerebral microbleeds (CMBs). However, hemodialysis (HD) patients have a high prevalence of CMBs and diverse pathologies that require antiplatelet therapy. In this study, we investigated whether the use of antiplatelet drugs increases the risk for ICH in HD patients with CMBs. Brain magnetic resonance imaging (MRI), including T2*-weighted MRI, was performed in 179 HD patients with no history of cerebrovascular events. CMBs were detected and patients were followed prospectively with a median follow-up period of 5.2 [1.4–6.2] years. To investigate whether the influence of antiplatelet therapy on the development of ICH differs in cases with and without CMBs, the inverse probability of treatment weighting method was used, including an interaction term between the presence or absence of CMBs and use of antiplatelet drugs. As a result, CMBs were detected in 45 patients (25.1%), and antiplatelet drugs were used in 66 patients (36.9%). When the effect of antiplatelet therapy on the incidence of ICH was modified by the presence of CMBs at baseline (P for interaction
ISSN:0967-5868
1532-2653
DOI:10.1016/j.jocn.2021.05.068