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Dr Chris Karayiannis published in The Lancet

A research project co-authored by Peninsula Health geriatrician, general physician and researcher Dr Chris Karayiannis, has been published in one of the world’s most prestigious publications, The Lancet Neurology journal.

The research deals with the question of what the more important risk is in people with ischemic events who also have cerebral microbleeds – the risk of ischemic stroke or haemorrhagic stroke?

“I did a research project when I was a registrar in geriatrics that looked at a group of patients who’d had a previous stroke and seeing how many of these lesions, called cerebral microbleeds, they had in their brains,” explains Dr Karayiannis.

“In that patient group it wasn’t really known how common these lesions were. That led to us contributing to this larger research project, looking at whether having these lesions in your brain increases your risk of bleeding if you are on blood thinners.”

Ischemic strokes are usually caused by a clot, so a lot of people who have had a previous stroke need to be on blood thinners. However for people who have had a stroke and have microbleeds in their brain, it was unknown whether these blood thinners may be dangerous.

To try and find an answer to this question, researchers from around the world analysed a clinical dataset of more than 20,000 people. 

“I used a database which had been collected of all patients who had been admitted with an ischemic stroke. I then went through all that data and worked with radiologists to look at an MRI scan and see if they had these lesions or not,” says Dr Karayiannis.

“Then we used their Electronic Medical Record to see whether or not they had suffered a subsequent stroke or brain haemorrhage in the following years.”

Dr Karayiannis’ study of around 300 people had similar results to the larger studies in the project.

“The larger studies found that even though people with more microbleeds were more likely to have a bleed, a hemorrhagic stroke, based on the number of bleeds they had they were still more likely to have an ischemic stroke caused by a clot than they were to have a bleed.”

“So it meant that it is probably better for these people to be on blood thinners, because we believe blood thinners will reduce the risk of ischemic stroke.”

“In other words, it didn’t seem to be harmful to put these people with microbleeds on blood thinners.”

Dr Karayiannis says the research was received with much interest when it was presented at the European Stroke Organisation in Milan in May.

“I think the research will probably affect practise because it will mean that if a doctor, neurologist or physician looks at somebody’s MRI scan and sees a lot of these lesions called microbleeds they’ll be able to be more confident that the patient will benefit from continuing on their blood thinners.”

“In the past we would have been uncertain what to do – do you continue the blood thinners or not?”

“It’s exciting to be published in the journal and be part of contributing to this evidence, which is the best we have available on the subject.” Dr Chis Karayiannis said.

Read more about the research online here.