Background: Silent brain lesions might be associated with overt cerebrovascular accident over time in beta thalassemia major (BTM) and intermediate (BTI) patients.

Aims: we evaluated brain MRI in thalassemia patients who had already performed brain MRI in order to see whether aspirin is protective or not over three years.

Methods: In this historical cohort study, 44 thalassemia patients (22 BTI and 22 BTM) were randomly selected by simple random sampling method from 46 BTM and 49 BTI patients who had performed brain MRI at baseline, 3 years before the end of the study. The inclusion criteria were no overt neurological defects and the patients underwent second MRI after three years follow up. The dose of aspirin was 80-100 mg once daily.

Results: Median age of the patients was 32 years and ranged from 8 to 42 years. Overall frequency of white matter lesions (WMLs) in the first MRI was 10 patients (28.6%). After 3 years, 3 patients developed new lesions and the frequency of WMLs was 13 patients (37.1%) in the second MRI. Moreover, in 3 patients, number of WMLs increased. Patients with new lesions or more lesions compared to the baseline were significantly older than the other group (median age 36.5 years vs. 31 years). Only 1 patient (16.7%) of those patients with new lesions was using aspirin compared to 10 (34.5%) of the other group.

Conclusions: Increased numbers of silent cerebral ischemia are found both in multi transfused and non-transfused patients with β-thalassemia. The high-risk patients with thrombocytosis, splenectomy, severe iron overload, and older age (>30 years) should be under close follow-up and evaluated on a regular periodic basis as well as brain MRI at least once every 3 years. Aspirin could be protective against new or progressive brain lesions so that low-dose aspirin is recommended in high-risk thalassemia patients.

[CT-scan of brain lesion in asymptomatic beta thalassemia intermediate patient: Hypodense ischemic i]

[A 25-year-old male BTM patient not splenectomized on regular blood transfusion Cranial MR axial Flai]

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/thromboembolism-in-thalassemia-patients-is-aspirin-protective-against-brain-ischemia-over-three-years-follow-up-in-beta-thalassemia-patients/