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Article: Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation

TitleImpact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation
Authors
Issue Date17-Mar-2023
PublisherWiley
Citation
Annals of Neurology, 2023, v. 94, n. 1, p. 61-74 How to Cite?
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 (adjusted hazard ratio [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 microbleed 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 to 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.


Persistent Identifierhttp://hdl.handle.net/10722/331784
ISSN
2023 Impact Factor: 8.1
2023 SCImago Journal Rankings: 3.600
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorSoo, Y-
dc.contributor.authorZietz, A-
dc.contributor.authorYiu, B-
dc.contributor.authorMok, VCT-
dc.contributor.authorPolymeris, AA-
dc.contributor.authorSeiffge, D-
dc.contributor.authorAmbler, G-
dc.contributor.authorWilson, D-
dc.contributor.authorLeung, TWH-
dc.contributor.authorTsang, SF-
dc.contributor.authorChu, W-
dc.contributor.authorAbrigo, J-
dc.contributor.authorCheng, C-
dc.contributor.authorLee, KJ-
dc.contributor.authorLim, JS-
dc.contributor.authorShiozawa, M-
dc.contributor.authorKoga, M-
dc.contributor.authorChabriat, H-
dc.contributor.authorHennerici, M-
dc.contributor.authorWong, YK-
dc.contributor.authorMak, H-
dc.contributor.authorCollet, R-
dc.contributor.authorInamura, S-
dc.contributor.authorYoshifuji, K-
dc.contributor.authorArsava, EM-
dc.contributor.authorHorstmann, S-
dc.contributor.authorPurrucker, J-
dc.contributor.authorLam, BYK-
dc.contributor.authorWong, A-
dc.contributor.authorKim, YD-
dc.contributor.authorSong, TJ-
dc.contributor.authorLemmens, R-
dc.contributor.authorEppinger, S-
dc.contributor.authorGattringer, T-
dc.contributor.authorLau, KK-
dc.contributor.authoret al-
dc.date.accessioned2023-09-21T06:58:53Z-
dc.date.available2023-09-21T06:58:53Z-
dc.date.issued2023-03-17-
dc.identifier.citationAnnals of Neurology, 2023, v. 94, n. 1, p. 61-74-
dc.identifier.issn0364-5134-
dc.identifier.urihttp://hdl.handle.net/10722/331784-
dc.description.abstract<p><strong>Objectives: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>A total of 7,839 patients were included. The presence of microbleeds was associated with an increased relative risk of intracranial hemorrhage (adjusted hazard ratio [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 microbleed 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 to 4 microbleeds (25 vs 12 per 1,000 patient-years) and ≥ 11 microbleeds (94 vs 48 per 1,000 patient-years).</p><p><strong>Interpretation: </strong>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.</p>-
dc.languageeng-
dc.publisherWiley-
dc.relation.ispartofAnnals of Neurology-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.titleImpact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation-
dc.typeArticle-
dc.identifier.doi10.1002/ana.26642-
dc.identifier.scopuseid_2-s2.0-85153280437-
dc.identifier.volume94-
dc.identifier.issue1-
dc.identifier.spage61-
dc.identifier.epage74-
dc.identifier.eissn1531-8249-
dc.identifier.isiWOS:000991988700001-
dc.identifier.issnl0364-5134-

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