JAMA Neurol: Prognostication and treatment of patients with micro-bleeding after stroke

Micro-bleeding of the brain is reported to lead to an increased risk of relapsed stroke and cerebral hemorrhage, so do patients with micro-bleeding from stroke and magnetic resonance imaging need anti-thrombosis treatment? Recently, researchers examined the effectiveness of anticoagulant and antiplate plate plate treatment in patients with unexplained embolic stroke (ESUS) micro-bleeding.
NAVIGATE ESUS study was conducted in 459 stroke centers in 31 countries in an international, double-blind, randomized, event-driven Phase III clinical study.
patients aged 50 or over who had neuroimaging-proven ESUS between 7 and 6 months before screening reported micro-bleeding in baseline clinical magnetic resonance imaging and were randomly received daily with 15 mg of devasalban or 100 mg of aspirin.
of the study was relapsed stroke, with secondary results being istemia stroke, cerebral hemorrhage, and all-cause mortality.
age of patients with cerebral micro-hemorrhage was 69.5 years, 241 men (61%) and 201 whites (51%).
old age (ratio ratio of 1.03 per year for OR), East Asian race (OR:1.57), hypertension (OR:2.20), multi-region infarction (OR:1.95), chronic infarction (OR:1.78), and hidden cerebral hemorrhage (OR:5.23) were independently associated with micro-hemorrhage. The presence of
micro-bleeding led to a 1.5-fold increase in the risk of relapsed stroke (risk ratio: 1.5), a 4-fold increase in the risk of cerebral hemorrhage (HR:4.2), a 2-fold increase in the risk of all-cause death (HR:2.1), and, strictly speaking, a 2.5-fold increase in the risk of ishemia stroke (HR:2.3).
for patients with micro-bleeding, the risk of cerebral hemorrhage after devasalban treatment is comparable to that of aspirin (HR:3.1 vs 3.0).
study found an increased risk of relapsed stroke, isomorrhagic stroke, cerebral hemorrhage and mortality in patients with micro-hemorrhage.