Brain Microbleeds in Senior Citizens May Be
Associated with Aspirin, Similar Drugs
This dangerous bleeding occurs when the walls of
blood vessels in the brain become weakened
April 13, 2009 Senior citizens taking aspiring, or
other medications that prevent blood clotting by inhibiting the
accumulation of platelets, appear more likely to have tiny, unexplained
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. A report from
this study lst year found these cerebral microbleeds are more common in people
age 60 and older than had been previously thought.
Cerebral microbleeds are lesions that can be seen
on brain scans, such as an MRI brain scan. The lesions are deposits of
the iron-storing protein hemosiderin - iron from red blood cells that
have presumably leaked from small brain vessels. They may also be a sign
of cerebral small-vessel disease, according to background information in
the article.
Earlier Reports on Cerebral Microbleeds
Very Common Among Senior Citizens
A report published in the April 1, 2008 edition of
Neurology, a journal from the American Academy of Nuerology,
found the overall prevalence of cerebral microbleeds was high and
increased with age from 17.8% in persons aged 60-69 years to 38.3% in
those over 80 years.
This research also reported that people with the e4
allele of the APOE gene, which is known to increase the risk of
Alzheimers disease and of cerebral amyloid angiopathy, had
significantly more microbleeds than people without this genetic variant.
African-Americans Have More Microbleeds
Then, another study published in Neurology,
this one in October of 2008, said cerebral microbleeds appear to be more
common in African-Americans than in Caucasians. The study found that
African-Americans had 32 percent more microbleeds than Caucasians, which
increases their likelihood of having a stroke.
This condition, recognized as 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.
Keep up with the latest news for senior citizens, baby
boomers
April 13, 2009 Senior citizens taking aspiring, or
other medications that prevent blood clotting by inhibiting the
accumulation of platelets, appear more likely to have tiny, unexplained
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. A report from
this study lst year found these cerebral microbleeds are more common in people
age 60 and older than had been previously thought.