Blood-thinning drugs increase the risk of cerebral hemorrhage – medical practice

Blood thinning as a cause of cerebral hemorrhage?

According to experts, about a million people in Germany regularly take anticoagulant drugs. It is designed to protect patients from heart attacks and strokes, among other things. So-called “blood thinners” can also increase the risk of dangerous bleeding. Researchers are now reporting the role these preparations play in cerebral haemorrhage.

Inselspital, University Hospital Bern, in collaboration with University College London, demonstrated the role of blood clots in cerebral hemorrhage in two comparative studies. The research team was able to identify cerebral microangiopathy, a disease that affects the small blood vessels in the brain, as the main cause. block Brain hemorrhage Therefore, emphasis must be placed on the localization and treatment of microangiopathies, as stated in one Message. Therefore blood thinning to protect against stroke is an essential option again in the future.

Understand exactly the causes and effects

As communication shows, cardiovascular diseases are usually complex and affect multiple organs at the same time. Therefore, treating vascular disease in the brain can have implications for treating heart disease. Therefore it is important to fully understand the causes and effects of each.

Present published in the journalJournal of Neurology, Neurosurgery and Psychiatry“A published study investigating the causes of cerebral hemorrhage and establishing a link with stroke risk in atrial fibrillation.

The scientific study proposes a fundamental new evaluation of the effects of blood thinning on cerebral hemorrhage.

Blood thinners are a risk factor

Cerebral haemorrhage is more lethal than other forms of stroke, and its frequency has not decreased in the past 30 years. Use of blood thinners was previously considered a potential risk factor and trigger for cerebral hemorrhage.

This publication includes the results of two studies and compares the contribution of blood clotting with that of brain microangiopathy in cerebral haemorrhage.

According to the information, it indicates that the moderate to severe disease of the smallest vessels in the brain is closely related to the occurrence of cerebral hemorrhage. “Our results show that the presence of microangiopathies is a prerequisite for cerebral hemorrhage when using blood thinners,” explains David Seiffge, chief physician at the Neurology Clinic, Inselspital, University Hospital Bern.

The degree of brain microangiopathy is appropriate for predicting cerebral hemorrhage. On the other hand, without microangiopathy, the risk of cerebral hemorrhage is minimal. It follows that blood clots should not be considered the main cause of cerebral hemorrhage.

Important protection against stroke

Blood thinning is an important protection against stroke in patients with atrial fibrillation. According to experts, anticoagulants reduce the risk of stroke here by two thirds.

Previously, if a cerebral haemorrhage occurred, anticoagulants were discontinued immediately and patients were put at risk of having a stroke.

However, the results of the new study now point to a new method: By treating disease of the smallest blood vessels in the brain, cerebral hemorrhage can be avoided, and thanks to continued blood thinning, certain protection against stroke can be maintained.

The exact timing and gradation of the two treatments are subject to further investigation.

A prerequisite for a cerebral hemorrhage

According to the letter, the publication is based on two independent, multi-center studies. On the other hand, a cross-sectional study was performed on 1030 patients with cerebral hemorrhage, in which the signs of brain microangiopathy were searched using CT and MRI scans.

In a second prospective study, 1,447 subjects were enrolled with atrial fibrillation and circulatory disorders in the brain. In this group, the incidence of cerebral hemorrhage and stroke was considered as a function of haemostasis.

With this approach it can be demonstrated that microangiopathy is a prerequisite for cerebral hemorrhage. Patients without this disease did not have a single brain hemorrhage in the study, despite the fact that they were treated with a blood thinner.

In contrast, the risk of developing moderate to severe microangiopathy increased 1.56% per year.

A new perspective is essential

According to the researchers, the study results indicate that a blood clot alone can no longer be considered a cause of cerebral hemorrhage.

“In order to prevent cerebral hemorrhage, microangiopathies must now be systematically searched for and specifically addressed. Adequate private consultation hours are available today. This would effectively and causally reduce the risk of cerebral hemorrhage in the case of atrial fibrillation,” says Professor Marcel Arnold, Head of the Stroke Physicians Center, Inselspital, University Hospital Bern.

A large international randomized study (ENRICH-AF) is currently being coordinated in Switzerland by David Seiffge, with the aim of coordinating anticoagulation and treatment of microangiopathies. (ad)