Prevalence of and risk factors for cerebral microbleeds among adult patients with haemophilia A or B

Cerebral microbleeds ( CMB s) represent clinically silent haemorrhagic events. Cerebral microbleeds ( CMB s) portend negative neurovascular and cognitive outcomes in the general population and are associated with cognitive impairment in persons with haemophilia ( PWH ). Prevalence, patterns, and risk factors for CMB s in PWH have not been directly compared to persons without coagulopathy. Aim To examine prevalence, patterns, and risk factors for CMB s in PWH vs normal controls. Methods Adults with haemophilia A or B and haemostatically normal controls were recruited. Subjects were excluded if taking an antithrombotic agent other than low‐dose aspirin (<100 mg). All subjects underwent T2* MRI of the brain; scans were reviewed independently by two neuroradiologists blinded to subject group to determine the presence of CMB s. Results We recruited 31 PWH and 32 controls. Human immunodeficiency virus ( HIV ) and history of hepatitis C virus ( HCV ) infection were more prevalent in PWH ; smoking was more common among controls. Cardiovascular ( CV ) risk factors were similar between groups. Prevalence of CMB s was 35% in PWH and 25% in controls ( P  = .42). Among PWH , advanced age, history of HCV infection, and CV risk factors were associated with CMB s. Multiple and large (>5 mm) CMB s were seen only in PWH . Conclusions Cerebral microbleeds ( CMB s) are common in adults with haemophilia, but not clearly more prevalent than in haemostatically normal controls. In PWH , older age, HCV infection, CV risk factors, and the presence of an inhibitor were associated with CMB s. Large CMB s and multiple CMB s may be more prevalent in PWH than in the general population. The clinical impact of CMB s in PWH requires further study.