Research summary
Associations of covert cerebrovascular changes on brain MRI with ICH risk and their evaluation to improve thrombolysis/antithrombotic safety in CVD.
What is the issue for NSW?
Covert cerebrovascular changes are a cause of thrombolysis/antithrombotic-related ICH. They are often neglected in patients with CVD but no neurological dysfunction and a history of stroke/TIA, since they have no brain image examination indication according to current clinical practice. However, among this clinical population, the prevalence of these changes is high, and thrombolysis/antithrombotic therapy is common. There have been rapid and substantial increases in antithrombotic demands in NSW and other places in Australia during the past decade, especially after the approval of novel oral anticoagulants. Therefore, improving thrombolysis/antithrombotic safety by reducing life-threatening bleeding (like ICH) risks is important. However, it remains unclear whether clinicians should use brain MRI to evaluate covert cerebrovascular changes for risk stratification before a thrombolysis/antithrombotic recipe decision.
What does the research aim to do and how?
This project aims to confirm the value of covert cerebrovascular changes in improving thrombolysis/antithrombotic safety for CVD. Firstly, we will conduct an IPD meta-analysis to determine the associations of CMBs with ICH risks after low-dose alteplase thrombolysis in AIS and whether AIS patients with (high-burden) CMBs may benefit from low-dose thrombolysis. Then, we will explore the safety of antithrombotic therapy guided by clinical plus brain imaging factors of covert cerebrovascular changes in patients with non-valvular AF through a multi-centre, single-blind RCT.
Published: 18 September 2026.