Austin Health

Title
Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation.
Publication Date
2023-03-17
Author(s)
Soo, Yannie
Zietz, Annaelle
Yiu, Brian
Mok, Vincent C T
Polymeris, Alexandros A
Seiffge, David
Ambler, Gareth
Wilson, Duncan
Leung, Thomas Wai Hong
Tsang, Suk Fung
Chu, Winnie
Abrigo, Jill
Cheng, Cyrus
Lee, Keon-Joo
Lim, Jae-Sung
Shiozawa, Masayuki
Koga, Masatoshi
Chabriat, Hugues
Hennerici, Michael
Wong, Yuen Kwun
Mak, Henry
Collet, Roger
Inamura, Shigeru
Yoshifuji, Kazuhisa
Arsava, Ethem Murat
Horstmann, Solveig
Purrucker, Jan
Lam, Bonnie Yk
Wong, Adrian
Kim, Young Dae
Song, Tae-Jin
Lemmens, Robin
Eppinger, Sebastian
Gattringer, Thomas
Uysal, Ender
Demirelli, Derya Selçuk
Bornstein, Natan M
Assayag, Einor Ben
Hallevi, Hen
Molad, Jeremy
Nishihara, Masashi
Tanaka, Jun
Coutts, Shelagh B
Kappelle, L Jaap
Al-Shahi Salman, Rustam
Jager, Rolf
Lip, Gregory Y H
Goeldlin, Martina B
Panos, Leonidas D
Mas, Jean-Louis
Legrand, Laurence
Karayiannis, Chris
Phan, Thanh
Bellut, Maximilian
Chappell, Francesca
Makin, Stephen
Hayden, Derek
Williams, David S
van Dam-Nolen, Dianne H K
Nederkoorn, Paul J
Barbato, Carmen
Browning, Simone
Wiegertjes, Kim
Tuladhar, Anil Man
Mendyk, Anne-Marie
Köhler, Sebastian
van Oostenburgge, Robert
Zhou, Ying
Xu, Chao
Hilal, Saima
Gyanwali, Bibek
Chen, Christopher
Lou, Min
Staals, Julie
Bordet, Regis
Kandiah, Nagaendran
de Leeuw, Frank-Erik
Simister, Robert
Hendrikse, Jeroen
Wardlaw, Joanna
Kelly, Peter
Fluri, Felix
Srikanth, Velandai
Calvet, David
Jung, Simon
Kwa, Vincent I H
Smith, Eric E
Hara, Hideo
Yakushiji, Yusuke
Necioglu Orken, Dilek
Fazekas, Franz
Thijs, Vincent N
Heo, Ji-Hoe
Veltkamp, Roland
Ay, Hakan
Imaizumi, Toshio
Lau, Kui Kai
Jouvent, Eric
Toyoda, Kazunori
Yoshimura, Sohei
Bae, Hee-Joon
Martí-Fàbregas, Joan
Prats-Sánchez, Luis
Lyrer, Philippe
Best, Jonathan
Werring, David
Engelter, Stefan T
Peters, Nils
Type of document
Journal Article
OrcId
0000-0002-3489-3201
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DOI
10.1002/ana.26642
Abstract
Cerebral microbleeds are associated with the risks of ischemic stroke and intracranial hemorrhage, causing clinical dilemmas for antithrombotic treatment decisions. We aimed to evaluate the risks of intracranial hemorrhage and ischemic stroke associated with microbleeds in patients with atrial fibrillation treated with Vitamin K antagonists, direct oral anticoagulants, antiplatelets, and combination therapy (i.e. concurrent oral anticoagulant and antiplatelet) METHODS: We included patients with documented atrial fibrillation from the pooled individual patient data analysis by the Microbleeds International Collaborative Network. Risks of subsequent intracranial hemorrhage and ischemic stroke were compared between patients with and without microbleeds, stratified by antithrombotic use. A total of 7,839 patients were included. The presence of microbleeds was associated with an increased relative risk of intracranial hemorrhage (aHR 2.74, 95% confidence interval 1.76 - 4.26) and ischemic stroke (aHR 1.29, 95% confidence interval 1.04 - 1.59). For the entire cohort, the absolute incidence of ischemic stroke was higher than intracranial hemorrhage regardless of microbleeds burden. However, for the subgroup of patients taking combination of anticoagulant and antiplatelet therapy, the absolute risk of intracranial hemorrhage exceeded that of ischemic stroke in those with 2-4 microbleeds (25 vs 12 per 1,000 patient-years) and ≥11 microbleeds (94 vs 48 per 1,000 patient-years). Patients with atrial fibrillation and high burden of microbleeds receiving combination therapy have a tendency of higher rate of intracranial hemorrhage than ischemic stroke, with potential for net harm. Further studies are needed to help optimize stroke preventive strategies in this high-risk group. This article is protected by copyright. All rights reserved.
Link
link
Citation
Annals of neurology 2023
Jornal Title
Annals of neurology
ISSN
1531-8249

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