New grant to improve safety of clot-busting treatment in people with cardiovascular disease

The George Institute’s Dr Zien Zhou has been awarded almost $1,000,000 over three years to evaluate the use of brain magnetic resonance imaging (MRI) to identify ‘hidden’ changes to blood vessels in the brain that may predict the risk of bleeding. It is hoped this will help guide the safest choice of anti-clotting therapy in patients with atrial fibrillation (AF), an irregular and often very rapid heart rhythm that can lead to the formation of blood clots.

The funding is from NSW Health’s Elite Postdoctoral Researcher Grants program, awarded to talented emerging cardiovascular research leaders who are ten years or less post doctorate.

The use of medications to treat or prevent thromboembolism - a common condition in patients with heart disease like AF in which blood vessels become blocked by the clumping together of platelets with fibrin and other blood cells - has increased substantially worldwide during the past decade.

Although these medications are effective, concerns remain over the risk of bleeding, especially in the brain - intracranial haemorrhage is a life-threatening complication with no proven treatment and a survival rate of less than 50 percent.

This is particularly important in patients with heart disease, who are two to three times more likely than the general population to have changes in their brain’s vascular system that can be clearly identified by MRI. While not sufficient to cause obvious neurological symptoms, these changes can result in subtle neurological deficits and increase the longer-term risk of stroke or dementia.

But patients with heart disease don’t routinely undergo brain imaging if they haven’t yet suffered a stroke, so these changes are usually overlooked, despite their potentially important role in choosing medications for these patients.

Dr Zhou’s study will help to determine whether hidden blood vessel changes identified by MRI are worth considering when deciding on the safest combination of antithrombotic or thrombolytic treatment for patients with AF.

Dr. Zhou obtained his specialist medical qualification in Neuroradiology from Shanghai Ren Ji Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, China.  He has been a visiting fellow and PhD candidate (UNSW Scientia Scholarship awardee) at The George Institute, Australia for the past six years. He is also a lead investigator for several other George Institute projects including the SAVE meta-analysis, the ENCHANTED imaging project, and secondary analyses for stroke outcome and AF events in the CANVAS/CREDENCE trials.