Impact of cerebral microbleeds in stroke patients with atrial fibrillation
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 a...
Gespeichert in:
| Hauptverfasser: | , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
July 2023
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| In: |
Annals of neurology
Year: 2023, Jahrgang: 94, Heft: 1, Pages: 61-74 |
| ISSN: | 1531-8249 |
| DOI: | 10.1002/ana.26642 |
| Online-Zugang: | Verlag, kostenfrei, Volltext: https://doi.org/10.1002/ana.26642 Verlag, kostenfrei, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.26642 
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| Verfasserangaben: | Yannie Soo, Annaelle Zietz, Brian Yiu, Vincent C. T. Mok, Alexandros A. Polymeris, David Seiffge, Gareth Ambler, Duncan Wilson, Thomas Wai Hong Leung, Suk Fung Tsang, Winnie Chu, Jill Abrigo, Cyrus Cheng, Keon-Joo Lee, Jae-Sung Lim, Masayuki Shiozawa, Masatoshi Koga, Hugues Chabriat, Michael Hennerici, Yuen Kwun Wong, Henry Mak, Roger Collet, Shigeru Inamura, Kazuhisa Yoshifuji, Ethem Murat Arsava, Solveig Horstmann, Jan Purrucker, Bonnie Y. K. Lam, Adrian Wong, Young Dae Kim, Tae-Jin Song, Robin Lemmens, Sebastian Eppinger, Thomas Gattringer, Ender Uysal, Derya Selçuk Demirelli, Natan M. Bornstein, Einor Ben Assayag, Hen Hallevi, Jeremy Molad, Masashi Nishihara, Jun Tanaka, Shelagh B. Coutts, L. Jaap Kappelle, Rustam Al-Shahi Salman, Rolf Jager, Gregory Y. H. Lip, Martina B. Goeldlin, Leonidas D. Panos, Jean-Louis Mas, Laurence Legrand, Chris Karayiannis, Thanh Phan, Maximilian Bellut, Francesca Chappell, Stephen Makin, Derek Hayden, David Williams, Dianne H. K. van Dam-Nolen, Paul J. Nederkoorn, Carmen Barbato, Simone Browning, Kim Wiegertjes, Anil Man Tuladhar, Anne-Marie Mendyk, Sebastian Köhler, Robert van Oostenburgge, Ying Zhou, Chao Xu, Saima Hilal, Bibek Gyanwali, Christopher Chen, Min Lou, Julie Staals, Regis Bordet, Nagaendran Kandiah, Frank-Erik de Leeuw, Robert Simister, Jeroen Hendrikse, Joanna Wardlaw, Peter Kelly, Felix Fluri, Velandai Srikanth, David Calvet, Simon Jung, I. H., Vincent Kwa, Eric E. Smith, Hideo Hara, Yusuke Yakushiji, Dilek Necioglu Orken, Franz Fazekas, Vincent Thijs, Ji-Hoe Heo, Roland Veltkamp, Hakan Ay, Toshio Imaizumi, Kui Kai Lau, Eric Jouvent, Kazunori Toyoda, Sohei Yoshimura, Hee-Joon Bae, Joan Martí-Fàbregas, Luis Prats-Sánchez, Philippe Lyrer, Jonathan Best, David Werring, Stefan T. Engelter, Nils Peters, the Microbleeds International Collaborative Network |
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| 245 | 1 | 0 | |a Impact of cerebral microbleeds in stroke patients with atrial fibrillation |c Yannie Soo, Annaelle Zietz, Brian Yiu, Vincent C. T. Mok, Alexandros A. Polymeris, David Seiffge, Gareth Ambler, Duncan Wilson, Thomas Wai Hong Leung, Suk Fung Tsang, Winnie Chu, Jill Abrigo, Cyrus Cheng, Keon-Joo Lee, Jae-Sung Lim, Masayuki Shiozawa, Masatoshi Koga, Hugues Chabriat, Michael Hennerici, Yuen Kwun Wong, Henry Mak, Roger Collet, Shigeru Inamura, Kazuhisa Yoshifuji, Ethem Murat Arsava, Solveig Horstmann, Jan Purrucker, Bonnie Y. K. Lam, Adrian Wong, Young Dae Kim, Tae-Jin Song, Robin Lemmens, Sebastian Eppinger, Thomas Gattringer, Ender Uysal, Derya Selçuk Demirelli, Natan M. Bornstein, Einor Ben Assayag, Hen Hallevi, Jeremy Molad, Masashi Nishihara, Jun Tanaka, Shelagh B. Coutts, L. Jaap Kappelle, Rustam Al-Shahi Salman, Rolf Jager, Gregory Y. H. Lip, Martina B. Goeldlin, Leonidas D. Panos, Jean-Louis Mas, Laurence Legrand, Chris Karayiannis, Thanh Phan, Maximilian Bellut, Francesca Chappell, Stephen Makin, Derek Hayden, David Williams, Dianne H. K. van Dam-Nolen, Paul J. Nederkoorn, Carmen Barbato, Simone Browning, Kim Wiegertjes, Anil Man Tuladhar, Anne-Marie Mendyk, Sebastian Köhler, Robert van Oostenburgge, Ying Zhou, Chao Xu, Saima Hilal, Bibek Gyanwali, Christopher Chen, Min Lou, Julie Staals, Regis Bordet, Nagaendran Kandiah, Frank-Erik de Leeuw, Robert Simister, Jeroen Hendrikse, Joanna Wardlaw, Peter Kelly, Felix Fluri, Velandai Srikanth, David Calvet, Simon Jung, I. H., Vincent Kwa, Eric E. Smith, Hideo Hara, Yusuke Yakushiji, Dilek Necioglu Orken, Franz Fazekas, Vincent Thijs, Ji-Hoe Heo, Roland Veltkamp, Hakan Ay, Toshio Imaizumi, Kui Kai Lau, Eric Jouvent, Kazunori Toyoda, Sohei Yoshimura, Hee-Joon Bae, Joan Martí-Fàbregas, Luis Prats-Sánchez, Philippe Lyrer, Jonathan Best, David Werring, Stefan T. Engelter, Nils Peters, the Microbleeds International Collaborative Network |
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| 520 | |a 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. ANN NEUROL 2023;94:61-74 | ||
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