Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation.
Publisher DOI
PubMed ID
36928609
Abstract
OBJECTIVES
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.
RESULTS
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).
INTERPRETATION
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.
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.
RESULTS
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).
INTERPRETATION
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.
Date Issued
2023-07
Publication Type
Article
Subject(s)
Language(s)
en
Author(s)
Soo, Yannie | |
Zietz, Annaelle | |
Yiu, Brian | |
Mok, Vincent C T | |
Polymeris, Alexandros A | |
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 | |
Mas, Jean-Louis | |
Legrand, Laurence | |
Karayiannis, Chris | |
Phan, Thanh | |
Bellut, Maximilian | |
Chappell, Francesca | |
Makin, Stephen | |
Hayden, Derek | |
Williams, David | |
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 | |
Kwa, Vincent I H | |
Smith, Eric E | |
Hara, Hideo | |
Yakushiji, Yusuke | |
Necioglu Orken, Dilek | |
Fazekas, Franz | |
Thijs, Vincent | |
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 |
Additional Credits
Journal
Annals of neurology
Publisher
Wiley
ISSN
1531-8249
Access(Rights)
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