The relationship between brain microbleeds and homeostatic markers in the treatment of ischemic stroke

Objectives: There is no definitive data regarding the usefulness of Brain microbleeds (BMBs) as an imaging marker with homeostatic markers to predict intracerebral hemorrhage (ICH) and ischemic stroke risk to personalize decisions on anticoagulation in AF. In this study, we prospectively evaluated clinical, radiological homeostatic biomarkers and their association with stroke outcomes in 73 AF-related ischemic stroke patients. Methods: All BMBs were measured manually on Susceptibility-Weighted Imaging (SWI). The levels of NT-pro-BNP, hs-CRP, FVII, FVIII and vWF were studied as homeostatic markers. For all patients, we calculated CHADS2, CHA2DS2-VASc, HAS-BLED scores and modified Rankin Scale (mRS) scores. Functional independence and good clinical outcome were defined as a mRS score of 0-2. Results: The mean age of the study population was 69.74 +/- 9.79 years, and 36 patients were female. The leading vascular risk factor was hypertension (61%). BMBs were determined in 20 patients (27.4%) on SWI, 12 patients had less than five lesions. Presence of BMBs lesions on SWI was significantly associated with age and hypertension (p = .020) and congestive heart failure (p = .011). The median CHA2DS2-VASc score in patients was 4.96 +/- 1.54. CHA2DS2-VASc score (p = .042), CHADS2 score (p = .037) and HAS- BLED score (p = .033) were significantly related with the presence of BMBs in the study patients. Among homeostatic markers, the levels of NT-pro-BNP, hs-CRP, and vWF were significantly associated with the presence of microbleeds (p = .013, p = .029, p = .020, respectively). Conclusion: Pathogenesis of AF is involved abnormal changes of hemostasis, endothelial dysfunction, antithrombotic state and inflammation. The homeostatic markers, which play role in these pathways, and the presence of BMBs could use to form a prognostic clinic assessment tool to predict bleeding risk.