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Cerebral microbleeds are a risk factor for warfarin-related intracerebral hemorrhage

From the Department of Neurology (S.-H.L., W.-S.R., J.-K.R.) and Clinical Research Center for Stroke, Clinical Research Institute (S.-H.L.), Seoul National University Hospital, Seoul, Republic of Korea.

Address correspondence and reprint requests to Dr. Jae-Kyu Roh, Department of Neurology, Seoul National University Hospital, 28 Yongon-dong, Jongno-gu, Seoul, 110-744, Republic of Korea rohjk{at}snu.ac.kr

Background: Cerebral microbleeds are known to be indicative of bleeding-prone microangiopathy and may predict incident intracerebral hemorrhage (ICH). In this study, we investigated whether microbleeds are associated with the incidence of warfarin-related ICH.

Methods: Twenty-four patients with ICH while on outpatient treatment with warfarin were selected from a consecutive cohort. Control, warfarin-using subjects with no history of ICH were randomly selected during the same time period (n = 48). We compared demographic factors, vascular risk factors, laboratory findings, and radiologic findings including microbleeds between the groups.

Result: There were more cases of patients with microbleeds in the ICH than control group (79.2% vs 22.9%: p < 0.001), and the number of microbleeds was much higher for the ICH group (9.0 ± 26.8 vs 0.5 ± 1.03: p < 0.001). Moreover, the number of microbleeds was significantly correlated with the presence of warfarin-related ICH (r = 0.299; p < 0.001). Conditional logistic regression analysis showed that increased prothrombin time and the presence of microbleeds were independently related to the incidence of warfarin-related ICH (microbleeds: adjusted OR, 83.12).

Conclusion: This study suggests that underlying microbleeds are independently associated with an incidence of warfarin-related intracerebral hemorrhage. Future research should focus on elucidating the risks and benefits of warfarin medication in patients with microbleeds.

Abbreviations: CI = confidence interval; GRE = gradient-echo; ICH = intracerebral hemorrhage; INR = international normalized ratio; NS = not significant; OR = odds ratio; PT = prothrombin time; WMH = white matter hyperintensity.

*These authors contributed equally.

Supported by grants of the Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea (A060143, A060171, and A060263).

Disclosure: The authors report no disclosures.

Supplemental data at www.neurology.org

Received April 21, 2008. Accepted in final form October 3, 2008.

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