Cerebral microbleeds (CMBs) are well-known markers for cerebral small vessel disease on magnetic resonance imaging (MRI). 1 Compared with other imaging markers for subclinical arteriolopathy in the brain, CMBs reflect a hemorrhage-prone state and are usually more associated with hypertension. 2 Because of its bleeding tendency, aspirin use has been suspected as a risk factor for CMBs. Although antiplatelet use has not been associated with the presence of CMBs in a few clinical studies, 3,4 a

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... ent meta-analysis showed a potential association between antiplatelet use and CMBs in stroke patients, 5 but not in stroke-free patients. 6 However, because of the heterogeneity of the study population and different bleeding risks in individual subjects, this association remains controversial. 7, 8 White matter hyperintensity (WMH) is another imag- Background: The association between antiplatelet use and cerebral microbleeds (CMBs) remains controversial. Herein, we investigated the effects of aspirin use on CMBs according to white matter hyperintensity (WMH) volume. Methods: CMBs were detected on gradient-recalled echo magnetic resonance imaging, and the volume of WMH was measured quantitatively. Information about aspirin use was obtained using a structured questionnaire, and other clinical and laboratory variables were investigated. The association between aspirin use and the presence of CMBs was evaluated according to WMH volume quartiles. Results: Among 1,642 neurologically asymptomatic subjects, 69 (4.2%) had CMBs and 126 (8%) had taken aspirin. The mean volume of WMH was 2.7 mL, and the average age was 56 years. The proportion of aspirin use did not differ between the two groups with or without CMBs (13% vs. 7%, respectively, p=0.11). In the highest quartile for WMH volume, the prevalence of CMBs and aspirin use increased compared with the lowest quartiles (10% vs. 1% for CMBs, and 11% vs. 4% for aspirin use). However, in each quartile of WMH volume, the proportion of aspirin use did not differ between subjects with and without CMBs. Chronological age and hypertension were associated with the presence of CMBs in both univariate and multivariate analyses after adjusting for WMH volume, but aspirin use did not increase the prevalence of CMBs in logistic regression analysis. Conclusion: Using WMH volume as a radiological marker for the vulnerable brain could not assist in distinguishing high-risk subjects for an increased prevalence of CMBs with regard to aspirin use.