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Published: Wednesday 16 May 2018 

Techniques to predict brain haemorrhage in people treated with anticoagulants after stroke caused by atrial fibrillation (CROMIS-2)

The CROMIS-2 study investigated whether signs of very small brain bleeds (cerebral microbleeds) on routine brain scans can help us understand which ischaemic stroke patients with an irregular heartbeat (atrial fibrillation) are at increased risk of a bigger bleed in the brain (intracerebral haemorrhage) from being on anticoagulant ‘blood thinning’ drugs.

The results were presented today at the European Stroke Organisation Conference in Gothenburg, Sweden, and also published in the journal, the Lancet Neurology.

Professor David Werring interviewed on CROMIS-2

The study followed up 1,477 patients recruited from UK hospitals for two years after a recent ischaemic stroke or transient ischaemic attack (TIA or ‘mini-stroke’). These patients had atrial fibrillation and were on anticoagulant medication; either warfarin or one of the direct oral anticoagulant (DOAC) drugs.

Patients included in the study had had MRI brain scans taken which could show signs of cerebral microbleeds. The analyses showed that patients who had signs of cerebral microbleeds on their brain scans had a higher risk of a future symptomatic bleed in the brain than those who did not, and that the increased risk was related to the amount of cerebral microbleeds found on the brain scans.

By accounting for the presence of cerebral microbleeds found on patient brain scans, it was found that a modified version of the ‘HAS-BLED’ clinical bleeding risk score could predict risk of bleeding in the brain more accurately than the standard HAS-BLED risk score. This modification could, therefore, help clinicians better identify patients at higher risk after stroke.

Juliet Bouverie, Chief Executive at the Stroke Association, which funded the study, along with the British Heart Foundation, said:

“Having AF, an irregular heartbeat, means your risk of stroke increases by up to five times. The main treatment to reduce your stroke risk is anticoagulant medication, also known as ‘blood-thinning’ drugs. In most people the benefits of taking anticoagulants outweigh the risks – one of which, for a small number of people, is excessive bleeding in the brain.

“It is vital that doctors can identify people who are at risk of excessive bleeding, so they can make informed decisions along with the patient about the most appropriate treatment option for them.”