Effect of combined clopidogrel-aspirin treatment for acute cerebral ischemic infarction on a correlation between cerebral microbleeds and hemorrhagic transformation / 中华老年医学杂志

ABSTRACT

Objective To investigate effects of combined clopidogrel-aspirin treatment for acute cerebral ischemie infarction on a correlation between cerebral microbleeds (CMBs)and hemorrhagic transformation(HT),so as to provide a new evidence for acute phase treatment of ischemic stroke with CMBs.Methods One hundred and forty-eighty patients with acute cerebral infarction meeting the inclusion criteria were consecutively admitted to our hospitals.All patients underwent susceptibility weighted imaging(SWI) to detect CMBs.Patients were classed into two groupswith and without CMBs and subdivided into brain lobe group,deep group and mixed group.The influence of CMBs or not and CMBs different positions on the post-infarction HT was compared.Logistic regression analysis was used to assess the relationship between HT and the related risk factors.Results The 142 patients finally were included in the study,with 64 patients without CMBs and 78 with CMBs.The detection rates of CMBs were 54.9％.Hypertensive prevalence rate(x2 =6.96,P =0.010)and the levels of uric acid (t =2.04,P =0.040) were higher in CMBs group than group without CMBs.The incidence rate of HT was 12.5 ％ (8 cases)in no CMBs group,and 21.8％(17 cases)in the CMBs group(x2 =2.09,P=0.150).6 in 15 patients(40.0％)patients experienced HT in lobar CMBs group;6 patients (12.5 ％)experienced HT in 48 patients with deep CMBs group;5 patients(33.3％)experienced HT in 15 patients with mixed CMBs group.There was statistically significant difference in HT incidence rate(x2 =6.52,P=0.038)among the 3 groups.Lobar CMBs are more vulnerable for HT.Logistic regression analysis showed that atrial fibrillation(OR=6.48,95 ％ CI2.45-17.19,P =0.000) and hyperglycemia (OR =1.02,95 ％ CI1.43 1.94,P =0.020) were risk factors for HT,instead of CMBs(OR=1.95,95％CI0.78-4.87,P=0.150).Conclusions CMBs do not increase the risk of hemorrhage transformation in cerebral ischemic infarction patients at acute stage with combined antithrombotic treatment.While,the double antithrombotic treatment used in patients with the lobar CMBs should be careful.