Antiplatelet Drug Use and Cerebral Microbleeds: A Meta-analysis of Published Studies

Abstract

Background: Antiplatelet therapy is a potential risk factor for intracerebral hemorrhage, and cerebral microbleeds reflect small perivascular hemorrhages without clinical symptoms. The question regarding whether antiplatelet therapy increases the risk of cerebral microbleeds has not yet reached a consensus.

Methods: We conducted a search in English database and extracted data from studies assessing the relationship between antiplatelet therapy and cerebral microbleeds. Then, we adopted the Review Manager 5.2 package to calculate pooled odds ratios (ORs) with the method of the inverse variance.

Results: We pooled data from 11 studies involving 10429 participants. The results revealed that there was a significant association between antiplatelet therapy and cerebral microbleeds in hemorrhagic stroke patients (OR, 1.96; 95% confidence interval [CI], 1.22-3.16) and ischemic stroke patients (OR, 1.65; 95% CI, 1.06-2.59), but not stroke-free population (OR, 1.30; 95% CI, .96-1.74). When stratified by population ethnicity, the association between antiplatelet therapy and cerebral microbleeds was significant in hemorrhagic stroke (OR, 2.26; 95% CI, 1.25-4.08) and ischemic stroke (OR, 2.18; 95% CI, 1.02-4.67) patients from Asian countries, but not significant in hemorrhagic stroke (OR, 1.95; 95% CI, .33-11.37) and ischemic stroke (OR, 1.16; 95% CI, .87-1.54) patients from European countries.

Conclusions: Antiplatelet therapy may increase the risk of cerebral microbleeds in stroke population. In addition, the relationship between antiplatelet therapy and cerebral microbleeds may be influenced by ethnic factors. More and larger prospective studies are urgently required to verify our results, because the studies to date are retrospective and the available data are limited.

Keywords: Antiplatelet drugs; aspirin; cerebral microbleeds (CMBs); clopidogrel.