Letter by Tsivgoulis et al Regarding Article, “Microbleeds, Cerebral Hemorrhage, and Functional Outcome After Stroke Thrombolysis: Individual Patient Data Meta-Analysis”
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To the Editor:
We read with great interest the recent meta-analysis by Charidimou et al1 on the association of cerebral microbleed (CMB) presence and burden identified on baseline magnetic resonance imaging of acute ischemic stroke (AIS) patients prior to tPA (tissue-type plasminogen activator) with the outcomes of intravenous thrombolysis (IVT). In their individual patient data meta-analysis (1973 patients and 8 centers), Charidimou et al1 reported that CMB presence was associated with a higher risk for parenchymal hemorrhage (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.09–2.07) but not with a higher risk for symptomatic intracerebral hemorrhage (sICH; OR, 1.42; 95% CI, 0.86–2.35). Likewise, the association of CMB presence with the 3 to 6 months poor functional outcome was marginally nonsignificant (risk ratio [RR], 1.26; 95% CI, 0.98–1.63). In contrast, high CMB burden (>10 …