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Aspirin
and similar Drugs may be associated with
Brain Microbleeds in Older Adults
Newswise
— Individuals who take aspirin or other
medications that prevent blood clotting by
inhibiting the accumulation of platelets
appear more likely to have tiny,
asymptomatic areas of bleeding in the brain,
according to a report posted online today
that will appear in the June print issue of
Archives of Neurology, one of the
JAMA/Archives journals.
Cerebral microbleeds—small deposits of the iron-storing
protein hemosiderin in the brain—may be a
sign of cerebral small-vessel disease,
according to background information in the
article.
This condition, common among older adults, occurs when the
walls of blood vessels in the brain become
weakened.
When microbleeds occur in certain brain areas, they may
indicate a type of small vessel disease
known as cerebral amyloid angiopathy, in
which the accumulation of amyloid (a protein
often related to Alzheimer’s disease) causes
degeneration of smooth muscle cells and
increases the susceptibility of blood
vessels to ruptures and hemorrhages.
Meike W. Vernooij, M.D., and colleagues at Erasmus MC
University Medical Center, Rotterdam, the
Netherlands, investigated the relationship
between cerebral microbleeds and the use of
anti-clotting medications in 1,062
individuals without dementia involved in the
Rotterdam Scan Study.
Participants (average age 69.6) underwent magnetic
resonance imaging examinations in 2005 and
2006. Pharmacy records were used to assess
whether any of the individuals took
anti-clotting drugs.
These included aspirin and carbasalate calcium—called
platelet aggregation inhibitors because they
prevent the accumulation of platelets that
form blood clots.
In the years before MRI, 363 (34.2 percent) of the
participants had used any anti-clotting
drugs, including 245 (23.1 percent) who took
platelet aggregation inhibitors (67 taking
aspirin and 141 taking carbasalate calcium).
Compared with patients who did not use anti-clotting drugs,
those who took aspirin or carbasalate
calcium were more likely to have cerebral
microbleeds visible on MRI. This association
was particularly strong among individuals
taking these drugs at higher doses,
typically used to treat or prevent heart
disease.
Microbleeds in the frontal lobe were more common among
aspirin users than carbasalate calcium
users. There was no association between
other types of anti-clotting drugs and
cerebral microbleeds.
“There is currently major interest in bleeding risks with
the use of antithrombotic or thrombolytic
treatment in persons who have microbleeds
that are apparent on MRI because this may
affect treatment in patients with
cardiovascular or cerebrovascular disease,”
the authors write.
“The cross-sectional design of our analyses prohibited an
investigation of whether persons with
cerebral microbleeds are at increased risk
for symptomatic hemorrhage [excessive
bleeding] when using platelet aggregation
inhibitors.”
The beneficial effects of anti-clotting drugs for
individuals at risk for heart attack and
stroke typically outweigh any risks of
bleeding, they note.
“Nevertheless, it may be that in selected persons
(e.g., those with signs of cerebral amyloid
angiopathy), this risk-benefit ratio may
differ for certain drugs (e.g., aspirin),
thus influencing treatment decision,” they
conclude.
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