Stroke Risk and Antithrombotic Treatment During Follow-up of Patients With Ischemic Stroke and Cortical Superficial Siderosis
Por:
Marti-Fabregas, J, Camps-Renom, P, Best, JG, Ramos-Pachon, A, Guasch-Jimenez, M, Martinez-Domeno, A, Guisado-Alonso, D, Gomez-Anson, BM, Ambler, G, Wilson, D, Lee, KJ, Lim, JS, Bae, HJ, Shiozawa, M, Koga, M, Toyoda, K, Hennerici, MG, Chabriat, H, Jouvent, E, Wong, DYK, Mak, H, Lau, KK, Kim, YD, Song, TJ, Heo, JH, Eppinger, S, Gattringer, T, Uysal, E, Demirelli, DS, Bornstein, N, Ben Assayag, E, Hallevi, H, Molad, JA, Nishihara, M, Tanaka, J, Hara, H, Yakushiji, Y, Coutts, SB, Smith, E, Polymeris, AA, Wagner, B, Seiffge, D, Lyrer, PA, Peters, N, Engelter, ST, Salman, RA, Jager, HR, Lip, GYH, Goeldlin, M, Panos, L, Karayiannis, CC, Phan, TG, Srikanth, VK, Christ, N, Gunkel, S, Fluri, F, Leung, TW, Soo, YOY, Chu, WN, Abrigo, J, Barbato, C, Browning, S, Simister, R, Mendyk, AM, Bordet, R, Hilal, S, Gyanwali, B, Chen, CSP, Jung, SM, Orken, DN, Werring, D, Prats-Sanchez, L
Publicada:
21 mar 2023
Ahead of Print:
19 dic 2022
Resumen:
Background and ObjectivesIn patients with ischemic stroke (IS) or transient ischemic attack (TIA) and cortical superficial siderosis (cSS), there are few data regarding the risk of future cerebrovascular events and also about the benefits and safety of antithrombotic drugs for secondary prevention. We investigated the associations of cSS and stroke risk in patients with recent IS or TIA.MethodsWe retrospectively analyzed the Microbleeds International Collaborative Network (MICON) database. We selected patients with IS or TIA from cohorts who had MRI-assessed cSS, available data on antithrombotic treatments, recurrent cerebrovascular events (intracranial hemorrhage [ICrH], IS, or any stroke [ICrH or IS]), and mortality. We calculated incidence rates (IRs) and performed univariable and multivariable Cox regression analyses.ResultsOf 12,669 patients (mean age 70.4 +/- 12.3 years, 57.3% men), cSS was detected in 273 (2.2%) patients. During a mean follow-up of 24 +/- 17 months, IS was more frequent than ICrH in both cSS (IR 57.1 vs 14.6 per 1,000 patient-years) and non-cSS (33.7 vs 6.3 per 1,000 patient-years) groups. Compared with the non-cSS group, cSS was associated with any stroke on multivariable analysis {IR 83 vs 42 per 1,000 patient-years, adjusted hazard ratio [HR] for cSS 1.62 (95% CI: 1.14-2.28; p = 0.006)}. This association was not significant in subgroups of patients treated with antiplatelet drugs (n = 6,554) or with anticoagulants (n = 4,044). Patients with cSS who were treated with both antiplatelet drugs and anticoagulants (n = 1,569) had a higher incidence of ICrH (IR 107.5 vs 4.9 per 1,000 patient-years, adjusted HR 13.26; 95% CI: 2.90-60.63; p = 0.001) and of any stroke (IR 198.8 vs 34.7 per 1,000 patient-years, adjusted HR 5.03; 95% CI: 2.03-12.44; p < 0.001) compared with the non-cSS group.DiscussionPatients with IS or TIA with cSS are at increased risk of stroke (ICrH or IS) during follow-up; the risk of IS exceeds that of ICrH for patients receiving antiplatelet or anticoagulant treatment alone, but the risk of ICrH exceeds that of IS in patients receiving both treatments. The findings suggest that either antiplatelet or anticoagulant treatment alone should not be avoided in patients with cSS, but combined antithrombotic therapy might be hazardous. Our findings need to be confirmed by randomized clinical trials.
Filiaciones:
Marti-Fabregas, J:
Hosp Santa Creu & Sant Pau, Biomed Res Inst Sant Pau, Dept Neurol, Barcelona, Spain
Camps-Renom, P:
Hosp Santa Creu & Sant Pau, Biomed Res Inst Sant Pau, Dept Neurol, Barcelona, Spain
Best, JG:
UCL, Inst Neurol, UCL Stroke Res Ctr, Dept Brain Repair & Rehabil, Queen Sq, London, England
Ramos-Pachon, A:
Hosp Santa Creu & Sant Pau, Biomed Res Inst Sant Pau, Dept Neurol, Barcelona, Spain
Guasch-Jimenez, M:
Hosp Santa Creu & Sant Pau, Biomed Res Inst Sant Pau, Dept Neurol, Barcelona, Spain
Martinez-Domeno, A:
Hosp Santa Creu & Sant Pau, Biomed Res Inst Sant Pau, Dept Neurol, Barcelona, Spain
Guisado-Alonso, D:
Hosp Santa Creu & Sant Pau, Biomed Res Inst Sant Pau, Dept Neurol, Barcelona, Spain
Gomez-Anson, BM:
Hosp Santa Creu & Sant Pau, Biomed Res Inst Sant Pau, Neuroradiol Unit, Dept Radiol, Barcelona, Spain
Ambler, G:
UCL, Dept Stat Sci, London, England
Wilson, D:
UCL, Inst Neurol, UCL Stroke Res Ctr, Dept Brain Repair & Rehabil, Queen Sq, London, England
Lee, KJ:
Seoul Natl Univ, Coll Med, Cerebrovasc Dis Ctr, Seoul, South Korea
Lim, JS:
Univ Ulsan, Coll Med, Asan Med Ctr, Dept Neurol, Ulsan, South Korea
Bae, HJ:
Seoul Natl Univ, Coll Med, Cerebrovasc Dis Ctr, Seoul, South Korea
Shiozawa, M:
Natl Cerebral & Cardiovasc Ctr, Dept Cerebrovasc Med, Suita, Japan
Koga, M:
Natl Cerebral & Cardiovasc Ctr, Dept Cerebrovasc Med, Suita, Japan
Toyoda, K:
Natl Cerebral & Cardiovasc Ctr, Dept Cerebrovasc Med, Suita, Japan
Hennerici, MG:
Heidelberg Univ, Federat Univ Med Mannheim, Heidelberg, Germany
Chabriat, H:
Lariboisiere Hosp, Assistance Publ Hop Paris, Translat Neurovasc Ctr, Dept Neurol, Paris, France
Jouvent, E:
Lariboisiere Hosp, Assistance Publ Hop Paris, Translat Neurovasc Ctr, Dept Neurol, Paris, France
Wong, DYK:
Univ Hong Kong, Dept Med, Div Neurol, Hong Kong, Peoples R China
Univ Hong Kong, Dept Diagnost Radiol, Hong Kong, Peoples R China
Mak, H:
Univ Hong Kong, Dept Med, Div Neurol, Hong Kong, Peoples R China
Univ Hong Kong, Dept Diagnost Radiol, Hong Kong, Peoples R China
Lau, KK:
Univ Hong Kong, Dept Med, Div Neurol, Hong Kong, Peoples R China
Univ Hong Kong, Dept Diagnost Radiol, Hong Kong, Peoples R China
Kim, YD:
Yonsei Univ, Coll Med, Dept Neurol, Seoul, South Korea
Song, TJ:
Yonsei Univ, Coll Med, Dept Neurol, Seoul, South Korea
Heo, JH:
Yonsei Univ, Coll Med, Dept Neurol, Seoul, South Korea
Eppinger, S:
Med Univ Graz, Dept Neurol, Graz, Austria
Gattringer, T:
Med Univ Graz, Dept Neurol, Graz, Austria
Uysal, E:
Saglik Bilimleri Univ, Hamidiye Etfal Educ & Res Hosp, Dept Neurol, Istanbul, Turkiye
Demirelli, DS:
Saglik Bilimleri Univ, Hamidiye Etfal Educ & Res Hosp, Dept Neurol, Istanbul, Turkiye
Bornstein, N:
Tel Aviv Sourasky Med Ctr, Dept Neurol, Tel Aviv, Israel
Ben Assayag, E:
Tel Aviv Sourasky Med Ctr, Dept Neurol, Tel Aviv, Israel
Hallevi, H:
Tel Aviv Sourasky Med Ctr, Dept Neurol, Tel Aviv, Israel
Molad, JA:
Tel Aviv Sourasky Med Ctr, Dept Neurol, Tel Aviv, Israel
Nishihara, M:
Saga Univ, Fac Med, Dept Radiol, Saga, Japan
Saga Univ, Fac Med, Dept Internal Med, Div Neurol, Saga, Japan
Tanaka, J:
Saga Univ, Fac Med, Dept Radiol, Saga, Japan
Saga Univ, Fac Med, Dept Internal Med, Div Neurol, Saga, Japan
Hara, H:
Saga Univ, Fac Med, Dept Radiol, Saga, Japan
Saga Univ, Fac Med, Dept Internal Med, Div Neurol, Saga, Japan
Yakushiji, Y:
Saga Univ, Fac Med, Dept Radiol, Saga, Japan
Saga Univ, Fac Med, Dept Internal Med, Div Neurol, Saga, Japan
Coutts, SB:
Univ Calgary, Hotchkiss Brain Inst, Dept Clin Neurosci Radiol & Community Hlth Sci, Calgary Stroke Program, Calgary, AB, Canada
Smith, E:
Univ Calgary, Hotchkiss Brain Inst, Dept Clin Neurosci Radiol & Community Hlth Sci, Calgary Stroke Program, Calgary, AB, Canada
Polymeris, AA:
Univ Hosp Basel, Dept Neurol, Basel, Switzerland
Univ Hosp Basel, Stroke Ctr, Basel, Switzerland
Univ Basel, Basel, Switzerland
Wagner, B:
Univ Hosp Basel, Dept Neurol, Basel, Switzerland
Univ Hosp Basel, Stroke Ctr, Basel, Switzerland
Univ Basel, Basel, Switzerland
Seiffge, D:
Univ Hosp Basel, Dept Neurol, Basel, Switzerland
Univ Hosp Basel, Stroke Ctr, Basel, Switzerland
Univ Basel, Basel, Switzerland
Lyrer, PA:
Univ Hosp Basel, Dept Neurol, Basel, Switzerland
Univ Hosp Basel, Stroke Ctr, Basel, Switzerland
Univ Basel, Basel, Switzerland
Peters, N:
Univ Hosp Basel, Dept Neurol, Basel, Switzerland
Univ Hosp Basel, Stroke Ctr, Basel, Switzerland
Univ Basel, Basel, Switzerland
Engelter, ST:
Univ Hosp Basel, Dept Neurol, Basel, Switzerland
Univ Hosp Basel, Stroke Ctr, Basel, Switzerland
Univ Basel, Basel, Switzerland
Salman, RA:
Univ Edinburgh, Ctr Clin Brain Sci, Sch Clin Sci, Edinburgh, Scotland
Jager, HR:
UCL, Inst Neurol, Lysholm Dept Neuroradiol, London, England
UCL, Inst Neurol, Dept Brain Repair & Rehabil, Neuroradiol Acad Unit, London, England
Natl Hosp Neurol & Neurosurg, London, England
Lip, GYH:
Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, England
Goeldlin, M:
Bern Univ Hosp, Dept Neurol, Inselspital, Bern, Switzerland
Univ Bern, Bern, Switzerland
Panos, L:
Bern Univ Hosp, Dept Neurol, Inselspital, Bern, Switzerland
Univ Bern, Bern, Switzerland
Karayiannis, CC:
Monash Univ, Peninsula Clin Sch, Peninsula Hlth & Stroke & Ageing Res Grp, Sch Clin Sci,Monash Hlth, Clayton, Vic, Australia
Phan, TG:
Monash Univ, Peninsula Clin Sch, Peninsula Hlth & Stroke & Ageing Res Grp, Sch Clin Sci,Monash Hlth, Clayton, Vic, Australia
Srikanth, VK:
Monash Univ, Peninsula Clin Sch, Peninsula Hlth & Stroke & Ageing Res Grp, Sch Clin Sci,Monash Hlth, Clayton, Vic, Australia
Christ, N:
Univ Hosp Wurzburg, Dept Neurol, Wurzburg, Germany
Gunkel, S:
Univ Hosp Wurzburg, Dept Neurol, Wurzburg, Germany
Fluri, F:
Univ Hosp Wurzburg, Dept Neurol, Wurzburg, Germany
Leung, TW:
Chinese Univ Hong Kong, Prince Wales Hosp, Dept Med & Therapeut, Hong Kong, Peoples R China
Soo, YOY:
Chinese Univ Hong Kong, Prince Wales Hosp, Dept Med & Therapeut, Hong Kong, Peoples R China
Chu, WN:
Chinese Univ Hong Kong, Prince Wales Hosp, Dept Med & Therapeut, Hong Kong, Peoples R China
Abrigo, J:
Chinese Univ Hong Kong, Prince Wales Hosp, Dept Med & Therapeut, Hong Kong, Peoples R China
Barbato, C:
UCL, Inst Neurol, UCL Stroke Res Ctr, Dept Brain Repair & Rehabil, Queen Sq, London, England
Browning, S:
UCL, Inst Neurol, UCL Stroke Res Ctr, Dept Brain Repair & Rehabil, Queen Sq, London, England
Simister, R:
UCL, Inst Neurol, UCL Stroke Res Ctr, Dept Brain Repair & Rehabil, Queen Sq, London, England
Mendyk, AM:
Univ Lille, Inserm, CHU Lille, Lille Neurosci & Cognit, Paris, France
Bordet, R:
Univ Lille, Inserm, CHU Lille, Lille Neurosci & Cognit, Paris, France
Hilal, S:
Natl Univ Singapore, Memory Aging & Cognit Ctr, Yong Loo Lin Sch Med, Singapore, Singapore
Gyanwali, B:
Natl Univ Singapore, Memory Aging & Cognit Ctr, Yong Loo Lin Sch Med, Singapore, Singapore
Chen, CSP:
Natl Univ Singapore, Memory Aging & Cognit Ctr, Yong Loo Lin Sch Med, Singapore, Singapore
Jung, SM:
Bern Univ Hosp, Dept Neurol, Inselspital, Bern, Switzerland
Univ Bern, Bern, Switzerland
Orken, DN:
Istanbul Arel Univ, Dept Neurol, Istanbul, Turkiye
Werring, D:
UCL, Inst Neurol, UCL Stroke Res Ctr, Dept Brain Repair & Rehabil, Queen Sq, London, England
Prats-Sanchez, L:
Hosp Santa Creu & Sant Pau, Biomed Res Inst Sant Pau, Dept Neurol, Barcelona, Spain
Green Published, All Open Access; Green
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