We aimed to explore the association between the prevalence of cerebral microbleeds (CMBs) on susceptibility-weighted imaging and prior antithrombotic therapy in ischemic stroke patients with atrial fibrillation (AF) and/or rheumatic heart disease (RHD) in China.

CMBs could contribute to an increased risk of intracerebral hemorrhage in patients with antithrombotic therapy (antiplatelets or anticoagulants). Antithrombotics are commonly prescribed to patients with AF and/or RHD for preventing ischemic stroke. However, the impact of antithrombotic therapy on CMBs remained controversial.

A total of 160 patients (68 males; median age, 71 years) were included. CMBs were observed in 90 (56.3%) patients, of whom 37 were with strictly lobar CMBs and 53 were with deep or infratentorial CMBs. There was a significant difference in antiplatelet use between patients with and without CMBs (33.3% vs. 11.4%, P=0.001), but not found in anticoagulants. Prior use of antiplatelets was independently associated with the presence of CMBs (OR=3.033, 95% CI: 1.168-7.878, P=0.023) and especially strictly lobar CMBs (OR=2.469, 95% CI: 1.040-5.861, P=0.040) in multivariate analysis.