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dc.contributor.authorCharidimou, Andreas-
dc.contributor.authorKarayiannis, Christopher-
dc.contributor.authorSong, Tae-Jin-
dc.contributor.authorOrken, Dilek Necioglu-
dc.contributor.authorThijs, Vincent-
dc.contributor.authorLemmens, Robin-
dc.contributor.authorKim, Jinkwon-
dc.contributor.authorGoh, Su Mei-
dc.contributor.authorPhan, Thanh G-
dc.contributor.authorSoufan, Cathy-
dc.contributor.authorChandra, Ronil V-
dc.contributor.authorSlater, Lee-Anne-
dc.contributor.authorHaji, Shamir-
dc.contributor.authorMok, Vincent-
dc.contributor.authorHorstmann, Solveig-
dc.contributor.authorLeung, Kam Tat-
dc.contributor.authorKawamura, Yuichiro-
dc.contributor.authorSato, Nobuyuki-
dc.contributor.authorHasebe, Naoyuki-
dc.contributor.authorSaito, Tsukasa-
dc.contributor.authorWong, Lawrence KS-
dc.contributor.authorSoo, Yannie-
dc.contributor.authorVeltkamp, Roland-
dc.contributor.authorFlemming, Kelly D-
dc.contributor.authorImaizumi, Toshio-
dc.contributor.authorSrikanth, Velandai-
dc.contributor.authorHeo, Ji Hoe-
dc.contributor.authorInternational META-MICROBLEEDS Initiative-
dc.identifier.citationNeurology 2017; 58(23): 2317-2326en_US
dc.description.abstractOBJECTIVES: To assess the association between cerebral microbleeds (CMBs) and future spontaneous intracerebral hemorrhage (ICH) risk in ischemic stroke patients with nonvalvular atrial fibrillation (AF) taking oral anticoagulants. METHODS: This was a meta-analysis of cohort studies with >50 patients with recent ischemic stroke and documented AF, brain MRI at baseline, long-term oral anticoagulation treatment, and ≥6 months of follow-up. Authors provided summary-level data on stroke outcomes stratified by CMB status. We estimated pooled annualized ICH and ischemic stroke rates from Poisson regression. We calculated odds ratios (ORs) of ICH by CMB presence/absence, ≥5 CMBs, and CMB topography (strictly lobar, mixed, and strictly deep) using random-effects models. RESULTS: We established an international collaboration and pooled data from 8 centers including 1,552 patients. The crude CMB prevalence was 30% and 7% for ≥5 CMBs. Baseline CMB presence (vs no CMB) was associated with ICH during follow-up (OR 2.68, 95% confidence interval [CI] 1.19-6.01, p = 0.017). Presence of ≥5 CMB was related to higher future ICH risk (OR 5.50, 95% CI 2.07-14.66, p = 0.001). The pooled annual ICH incidence increased from 0.30% (95% CI 0.04-0.55) among CMB-negative patients to 0.81% (95% CI 0.17-1.45) in CMB-positive patients (p = 0.01) and 2.48% (95% CI 1.2-6.2) in patients with ≥5 CMBs (p = 0.001). There was no association between CMBs and recurrent ischemic stroke. CONCLUSIONS: The presence of CMB on MRI and the dichotomized cutoff of ≥5 CMBs might identify subgroups of ischemic stroke patients with AF with high ICH risk and after further validation could help in risk stratification, in anticoagulation decisions, and in guiding randomized trials and ongoing large observational studies.en_US
dc.subjectAtrial Fibrillationen_US
dc.subjectCerebral Hemorrhageen_US
dc.titleBrain microbleeds, anticoagulation, and hemorrhage risk: Meta-analysis in stroke patients with AFen_US
dc.typeJournal Articleen_US
dc.identifier.affiliationJ. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USAen_US
dc.identifier.affiliationHarvard Medical School, Boston, MA, USAen_US
dc.identifier.affiliationMETA-MICROBLEEDS Initiative/Consortium, Boston, MA, USAen_US
dc.identifier.affiliationStroke and Ageing Research Centre, Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australiaen_US
dc.identifier.affiliationDepartment of Neurology, Yonsei University College of Medicine, Seoul, Koreaen_US
dc.identifier.affiliationSisli Hamidiye Etfal Education and Research Hospital, Department of Neurology, Istanbul, Turkeyen_US
dc.identifier.affiliationDepartment of Neurology, Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australiaen_US
dc.identifier.affiliationDepartment of Neurology, CHA Bundang Medical Centre, CHA University, Seongnam, Koreaen_US
dc.identifier.affiliationStroke Unit, Neurosciences, Monash Imaging, Monash Health, Melbourne, Victoria, Australiaen_US
dc.identifier.affiliationNeuroradiology Service, Monash Imaging, Monash Health, Melbourne, Victoria, Australiaen_US
dc.identifier.affiliationDepartment of Neurology, Mayo Clinic, Rochester, MN, USAen_US
dc.identifier.affiliationDepartment of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kongen_US
dc.identifier.affiliationDepartment of Neurology, University of Heidelberg, Germanyen_US
dc.identifier.affiliationDepartment of Internal Medicine, Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japanen_US
dc.identifier.affiliationDepartment of Stroke Medicine, Division of Brain Sciences, Imperial College London, UKen_US
dc.identifier.affiliationDepartment of Neurosurgery, Kushiro City General Hospital, Hokkaido, Japanen_US
dc.identifier.affiliationKU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease, Belgiumen_US
dc.identifier.affiliationVIB, Vesalius Research Center, Laboratory of Neurobiology, Belgiumen_US
dc.identifier.affiliationUniversity Hospitals Leuven, Department of Neurology, Belgiumen_US
dc.identifier.affiliationDepartment of Neurology, College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Koreaen_US
dc.type.austinJournal Articleen_US
item.fulltextNo Fulltext-
item.openairetypeJournal Article-
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