Microbleeds and the Effect of Anticoagulation in Patients With Embolic Stroke of Undetermined Source: An Exploratory Analysis of the NAVIGATE ESUS Randomized Clinical Trial
Analysis (n=3699) found those with cerebral microbleeds had higher rates of recurrent stroke, ischaemic stroke, intracerebral haemorrhage, and mortality during 11 months of follow-up, but this did not appear to influence the effects of rivaroxaban (15mg) on clinical outcomes.
Source:
JAMA Neurology
SPS commentary:
An editorial suggests that because the presence of cerebral microbleeds (CMBs) does not seem to modify the effect of rivaroxaban on clinical outcomes, their use in guiding anticoagulation therapy decision-making is then questionable. It notes that current evidence does not justify avoiding antithrombotic medication in patients with stroke based solely on the presence of CMBs, but clinicians would like to be able to identify which patients will be at risk of severe bleeding complications when treating them with anticoagulants. It adds that risk scores such as HAS-BLED or HEMORR2HAGES are of limited value; including CMBs alone in such scores remains insufficient for clinical practice.