TY - JOUR
T1 - Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation
AU - the Microbleeds International Collaborative Network
AU - Soo, Yannie
AU - Zietz, Annaelle
AU - Yiu, Brian
AU - Mok, Vincent C. T.
AU - Polymeris, Alexandros A.
AU - Seiffge, David
AU - Ambler, Gareth
AU - Wilson, Duncan
AU - Leung, Thomas Wai Hong
AU - Tsang, Suk Fung
AU - Chu, Winnie
AU - Abrigo, Jill
AU - Cheng, Cyrus
AU - Lee, Keon-Joo
AU - Lim, Jae-Sung
AU - Shiozawa, Masayuki
AU - Koga, Masatoshi
AU - Chabriat, Hugues
AU - Hennerici, Michael
AU - Wong, Yuen Kwun
AU - Mak, Henry
AU - Collet, Roger
AU - Inamura, Shigeru
AU - Yoshifuji, Kazuhisa
AU - Arsava, Ethem Murat
AU - Horstmann, Solveig
AU - Purrucker, Jan
AU - Lam, Bonnie Y. K.
AU - Wong, Adrian
AU - Kim, Young Dae
AU - Song, Tae-Jin
AU - Lemmens, Robin
AU - Eppinger, Sebastian
AU - Gattringer, Thomas
AU - Uysal, Ender
AU - Demirelli, Derya Selçuk
AU - Bornstein, Natan M.
AU - Assayag, Einor Ben
AU - Hallevi, Hen
AU - Molad, Jeremy
AU - Nishihara, Masashi
AU - Tanaka, Jun
AU - Coutts, Shelagh B.
AU - Kappelle, L. Jaap
AU - Salman, Rustam Al-Shahi
AU - Jager, Rolf
AU - Lip, Gregory Y. H.
AU - Goeldlin, Martina B.
AU - Panos, Leonidas D.
AU - Nederkoorn, Paul J.
N1 - Funding Information: This study was funded by the Swiss Heart Foundation. Furthermore, the study was funded in part by Wellcome Trust (WT088134/Z/09/A) and for the purpose of open access, co‐authors have applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. The authors would like to thank the patients that participated in the various cohorts. Open access funding provided by Universität Basel. Funding Information: This study was funded by the Swiss Heart Foundation. Furthermore, the study was funded in part by Wellcome Trust (WT088134/Z/09/A) and for the purpose of open access, co-authors have applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. The authors would like to thank the patients that participated in the various cohorts. Open access funding provided by Universitat Basel. Publisher Copyright: © 2023 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.
PY - 2023/7
Y1 - 2023/7
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85153280437&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/ana.26642
DO - https://doi.org/10.1002/ana.26642
M3 - Article
C2 - 36928609
SN - 0364-5134
VL - 94
SP - 61
EP - 74
JO - Annals of neurology
JF - Annals of neurology
IS - 1
ER -