Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation
Por:
Soo, Y, Zietz, A, Yiu, B, Mok, VCT, Polymeris, AA, Seiffge, D, Ambler, G, Wilson, D, Leung, TWH, Tsang, SF, Chu, W, Abrigo, J, Cheng, C, Lee, KJ, Lim, JS, Shiozawa, M, Koga, M, Chabriat, H, Hennerici, M, Wong, YK, Mak, H, Collet, R, Inamura, S, Yoshifuji, K, Arsava, EM, Horstmann, S, Purrucker, J, Lam, BYK, Wong, A, Kim, YD, Song, TJ, Lemmens, R, Eppinger, S, Gattringer, T, Uysal, E, Demirelli, DS, Bornstein, NM, Ben Assayag, E, Hallevi, H, Molad, J, Nishihara, M, Tanaka, J, Coutts, SB, Kappelle, LJ, Salman, RA, Jager, R, Lip, GYH, Goeldlin, MB, Panos, LD, Mas, JL, Legrand, L, Karayiannis, C, Phan, T, Bellut, M, Chappell, F, Makin, S, Hayden, D, Williams, D, van Dam-Nolen, DHK, Nederkoorn, PJ, Barbato, C, Browning, S, Wiegertjes, K, Tuladhar, AM, Mendyk, AM, Kohler, S, van Oostenburgge, R, Zhou, Y, Xu, C, Hilal, S, Gyanwali, B, Chen, C, Lou, M, Staals, J, Bordet, R, Kandiah, N, de Leeuw, FE, Simister, R, Hendrikse, J, Wardlaw, J, Kelly, P, Fluri, F, Srikanth, V, Calvet, D, Jung, S, Kwa, VIH, Smith, EE, Hara, H, Yakushiji, Y, Orken, DN, Fazekas, F, Thijs, V, Heo, JH, Veltkamp, R, Ay, H, Imaizumi, T, Lau, KK, Jouvent, E, Toyoda, K, Yoshimura, S, Bae, HJ, Marti-Fabregas, J, Prats-Sanchez, L, Lyrer, P, Best, J, Werring, D, Engelter, ST, Peters, N
Publicada:
1 jul 2023
Ahead of Print:
1 abr 2023
Resumen:
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.
Filiaciones:
Soo, Y:
Chinese Univ Hong Kong, Prince Wales Hosp, Div Neurol, Dept Med & Therapeut,Shatin, Hong Kong, Peoples R China
Zietz, A:
Univ Hosp Basel, Dept Neurol, Basel, Switzerland
Univ Hosp Basel, Stroke Ctr, Basel, Switzerland
Univ Basel, Basel, Switzerland
Yiu, B:
Chinese Univ Hong Kong, Prince Wales Hosp, Div Neurol, Dept Med & Therapeut,Shatin, Hong Kong, Peoples R China
Mok, VCT:
Chinese Univ Hong Kong, Prince Wales Hosp, Div Neurol, Dept Med & Therapeut,Shatin, Hong Kong, Peoples R China
Chinese Univ Hong Kong, Gerald Choa Neurosci Inst,Margaret KL Cheung Res, Therese Pei Fong Chow Res Ctr Prevent Dementia,Lu, Li Ka Shing Inst Hlth Sci,Lau Tat Chuen Res Ctr B, Hong Kong, Peoples R China
Polymeris, AA:
Univ Hosp Basel, Dept Neurol, Basel, Switzerland
Univ Hosp Basel, Stroke Ctr, Basel, Switzerland
Univ Basel, Basel, Switzerland
Seiffge, D:
Univ Bern, Univ Hosp Bern, Dept Neurol, Inselspital, Bern, Switzerland
Ambler, G:
UCL, Dept Stat Sci, London, England
Wilson, D:
UCL Queen Sq Inst Neurol, Stroke Res Ctr, Dept Brain Repair & Rehabil, London, England
New Zealand Brain Res Inst, Christchurch, New Zealand
Leung, TWH:
Chinese Univ Hong Kong, Prince Wales Hosp, Div Neurol, Dept Med & Therapeut,Shatin, Hong Kong, Peoples R China
Tsang, SF:
Chinese Univ Hong Kong, Prince Wales Hosp, Div Neurol, Dept Med & Therapeut,Shatin, Hong Kong, Peoples R China
Chu, W:
Chinese Univ Hong Kong, Prince Wales Hosp, Dept Imaging & Intervent Radiol, Shatin, Hong Kong, Peoples R China
Abrigo, J:
Chinese Univ Hong Kong, Prince Wales Hosp, Dept Imaging & Intervent Radiol, Shatin, Hong Kong, Peoples R China
Cheng, C:
Chinese Univ Hong Kong, Prince Wales Hosp, Div Neurol, Dept Med & Therapeut,Shatin, Hong Kong, Peoples R China
Lee, KJ:
Korea Univ, Dept Neurol, Guro Hosp, Seoul, South Korea
Lim, JS:
Univ Ulsan, Dept Neurol, Asan Med Ctr, Coll Med, Seoul, South Korea
Shiozawa, M:
Natl Cerebral & Cardiovasc Ctr, Dept Cerebrovasc Med, Suita, Osaka, Japan
Koga, M:
Natl Cerebral & Cardiovasc Ctr, Dept Cerebrovasc Med, Suita, Osaka, Japan
Chabriat, H:
Lariboisiere Hosp, AP HP, Translat Neurovasc Ctr, F-75475 Paris, France
Univ Paris, FHU NeuroVasc, Paris, France
INSERM, U1141, Paris, France
Hennerici, M:
Heidelberg Univ, Dept Neurol, Mannheim Hosp, Mannheim, Germany
Wong, YK:
Univ Hong Kong, Dept Med, Div Neurol, Hong Kong, Peoples R China
Mak, H:
Univ Hong Kong, Dept Diagnost Radiol, Hong Kong, Peoples R China
Collet, R:
Hosp Santa Creu & Sant Pau, Dept Neurol, Biomed Res Inst, Barcelona, Spain
Inamura, S:
Kushiro City Gen Hosp, Dept Neurosurg, Kushiro, Japan
Yoshifuji, K:
Kushiro City Gen Hosp, Dept Neurosurg, Kushiro, Japan
Arsava, EM:
Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurol, Boston, MA USA
Harvard Med Sch, Massachusetts Gen Hosp, Dept Radiol, Boston, MA USA
Horstmann, S:
Heidelberg Univ Hosp, Dept Neurol, Heidelberg, Germany
Purrucker, J:
Heidelberg Univ Hosp, Dept Neurol, Heidelberg, Germany
Lam, BYK:
Chinese Univ Hong Kong, Prince Wales Hosp, Div Neurol, Dept Med & Therapeut,Shatin, Hong Kong, Peoples R China
Chinese Univ Hong Kong, Gerald Choa Neurosci Inst,Margaret KL Cheung Res, Therese Pei Fong Chow Res Ctr Prevent Dementia,Lu, Li Ka Shing Inst Hlth Sci,Lau Tat Chuen Res Ctr B, Hong Kong, Peoples R China
Wong, A:
Chinese Univ Hong Kong, Gerald Choa Neurosci Inst,Margaret KL Cheung Res, Therese Pei Fong Chow Res Ctr Prevent Dementia,Lu, Li Ka Shing Inst Hlth Sci,Lau Tat Chuen Res Ctr B, Hong Kong, Peoples R China
Kim, YD:
Yonsei Univ, Dept Neurol, Coll Med, Seoul, South Korea
Song, TJ:
Ewha Womans Univ, Dept Neurol, Coll Med, Seoul Hosp, Seoul, South Korea
Lemmens, R:
Univ Leuven, Dept Neurosci, KU Leuven, Expt Neurol, Leuven, Belgium
VIB Ctr Brain & Dis Res, Leuven, Belgium
Univ Hosp Leuven, Dept Neurol, Leuven, Belgium
Eppinger, S:
Med Univ Graz, Dept Neurol, Graz, Austria
Med Univ Graz, Dept Radiol, Div Neuroradiol Vasc & Intervent Radiol, Graz, Austria
Gattringer, T:
Med Univ Graz, Dept Neurol, Graz, Austria
Med Univ Graz, Dept Radiol, Div Neuroradiol Vasc & Intervent Radiol, Graz, Austria
Uysal, E:
Univ Hlth Sci Turkey, Antalya Teaching & Res Hosp, Dept Radiol, Antalya, Turkiye
Demirelli, DS:
Univ Hlth Sci Turkey, Sisli Hamidiye Etfal Teaching & Res Hosp, Dept Neurol, Antalya, Turkiye
Bornstein, NM:
Tel Aviv Sourasky Med Ctr, Dept Neurol, Tel Aviv, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
Ben Assayag, E:
Tel Aviv Sourasky Med Ctr, Dept Neurol, Tel Aviv, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
Hallevi, H:
Tel Aviv Sourasky Med Ctr, Dept Neurol, Tel Aviv, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
Molad, J:
Tel Aviv Sourasky Med Ctr, Dept Neurol, Tel Aviv, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
Nishihara, M:
Saga Univ, Dept Radiol, Fac Med, Saga, Japan
Tanaka, J:
St Marys Hosp, Dept Cerebrovasc Med, Kurume, Fukuoka, Japan
Coutts, SB:
Univ Calgary, Hotchkiss Brain Inst, Dept Clin Neurosci Radiol & Community Hlth Sci, Calgary Stroke Program, Calgary, AB, Canada
Kappelle, LJ:
Univ Med Ctr Utrecht, Dept Neurol & Neurosurg, Utrecht, Netherlands
Univ Utrecht, Utrecht, Netherlands
Salman, RA:
Univ Edinburgh, Sch Clin Sci, Ctr Clin Brain Sci, Edinburgh, Midlothian, Scotland
Jager, R:
UCL Inst Neurol, Lysholm Dept Neuroradiol, London, England
UCL Inst Neurol, Neuroradiol Acad Unit, Dept Brain Repair & Rehabil, London, England
Natl Hosp Neurol & Neurosurg, London, England
Lip, GYH:
Univ Liverpool, Liverpool Ctr Cardiovascular Sci, Liverpool, Merseyside, England
Liverpool John Moores Univ, Liverpool, Merseyside, England
Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England
Aalborg Univ, Dept Clin Med, Aalborg, Denmark
Goeldlin, MB:
Univ Bern, Univ Hosp Bern, Dept Neurol, Inselspital, Bern, Switzerland
Panos, LD:
Univ Bern, Univ Hosp Bern, Dept Neurol, Inselspital, Bern, Switzerland
Mas, JL:
St Anne Hosp, GHU Paris Psychiat & Neurosci, Dept Neurol, Paris, France
St Anne Hosp, GHU Paris Psychiat & Neurosci, Stroke Unit, Paris, France
Univ Paris Cite, INSERM, U1266, Inst Psychiat & Neurosci Paris, Paris, France
Legrand, L:
Univ Paris Cite, INSERM, U1266, Inst Psychiat & Neurosci Paris, Paris, France
St Anne Hosp, Dept Neuroradiol, GHU Paris Psychiat & Neurosci, Paris, France
Karayiannis, C:
Monash Univ, Peninsula Clin Sch, Peninsula Hlth, Melbourne, Vic, Australia
Phan, T:
Monash Univ, Monash Hlth, Sch Clin Sci, Stroke & Ageing Res Grp, Melbourne, Vic, Australia
Bellut, M:
Univ Hosp Wurzburg, Dept Neurol, Wurzburg, Germany
Chappell, F:
Edinburgh Imaging, Ctr Clin Brain Sci, Edinburgh, Midlothian, Scotland
Univ Edinburgh, UK Dementia Inst, Edinburgh, Midlothian, Scotland
Makin, S:
Univ Aberdeen, Inst Appl Hlth Sci, Ctr Rural Hlth, Aberdeen, Scotland
Hayden, D:
Tallaght Univ Hosp, Acute Med Unit, Dublin, Ireland
Tallaght Univ Hosp, Dept Age Related Healthcare, Dublin, Ireland
Williams, D:
RCSI Univ Med & Hlth Sci Dublin, Dept Geriatr & Stroke Med, Dublin, Ireland
Beaumont Hosp Dublin, Dublin, Ireland
van Dam-Nolen, DHK:
Erasmus MC, Dept Radiol & Nucl Med, Rotterdam, Netherlands
Nederkoorn, PJ:
Univ Amsterdam, Dept Neurol, Med Ctr, Amsterdam, Netherlands
Barbato, C:
Univ Florence, Dept Neurol, Florence, Italy
Browning, S:
UCL Queen Sq Inst Neurol, Dept Brain Repair & Rehabil, Stroke Res Ctr, London, England
Univ Coll London Hosp NHS Trust, Comprehens Stroke Serv, London, England
Wiegertjes, K:
Radboud Univ Nijmegen, Med Ctr, Dept Neurol, Donders Inst Brain Cognit & Behav,Donders Ctr Med, Nijmegen, Netherlands
Tuladhar, AM:
Radboud Univ Nijmegen, Med Ctr, Dept Neurol, Donders Inst Brain Cognit & Behav,Donders Ctr Med, Nijmegen, Netherlands
Mendyk, AM:
Univ Lille, INSERM, CHU Lille, Lille Neurosci & Cognit, Lille, France
Kohler, S:
Maastricht Univ, Dept Psychiat & Neuropsychol, Sch Mental Hlth & Neurosci MHeNs, Maastricht, Netherlands
van Oostenburgge, R:
Maastricht Univ, Med Ctr, Dept Neurol, Cardiovasc Res Inst Maastricht CARIM, Maastricht, Netherlands
Zhou, Y:
Zhejiang Univ, Sch Med, Dept Neurol, Affiliated Hosp 2, Hangzhou, Peoples R China
Xu, C:
Zhejiang Univ, Sch Med, Dept Neurol, Affiliated Hosp 2, Hangzhou, Peoples R China
Hilal, S:
Natl Univ Singapore, Saw Swee Hock Sch Publ Hlth, Singapore, Singapore
Natl Univ Hlth Syst, Singapore, Singapore
Gyanwali, B:
Natl Univ Singapore, Yong Loo Lin Sch Med, Memory Aging & Cognit Ctr, Singapore, Singapore
Chen, C:
Natl Univ Singapore, Yong Loo Lin Sch Med, Memory Aging & Cognit Ctr, Singapore, Singapore
Lou, M:
Zhejiang Univ, Sch Med, Dept Neurol, Affiliated Hosp 2, Hangzhou, Peoples R China
Staals, J:
Maastricht Univ, Med Ctr, Dept Neurol, Cardiovasc Res Inst Maastricht CARIM, Maastricht, Netherlands
Bordet, R:
Univ Lille, INSERM, CHU Lille, Lille Neurosci & Cognit, Lille, France
Kandiah, N:
Lee Kong Chian Sch Med, Dementia Res Ctr Singapore, Singapore, Singapore
de Leeuw, FE:
Radboud Univ Nijmegen, Med Ctr, Dept Neurol, Donders Inst Brain Cognit & Behav,Donders Ctr Med, Nijmegen, Netherlands
Simister, R:
UCL Queen Sq Inst Neurol, Dept Brain Repair & Rehabil, Stroke Res Ctr, London, England
Univ Coll London Hosp NHS Trust, Comprehens Stroke Serv, London, England
Hendrikse, J:
Univ Med Ctr Utrecht, Dept Radiol & Nucl Med, Utrecht, Netherlands
Wardlaw, J:
Edinburgh Imaging, Div Neuroimaging Sci, Edinburgh, Midlothian, Scotland
Univ Edinburgh, UK Dementia Res Inst, Edinburgh, Midlothian, Scotland
NHS Lothian, Edinburgh, Midlothian, Scotland
Kelly, P:
Univ Coll Dublin, Neurovasc Res Unit, Stroke Clin Trials Network Ireland, Dublin, Ireland
Univ Coll Dublin, Hlth Res Board, Stroke Clin Trials Network Ireland, Dublin, Ireland
Fluri, F:
Univ Hosp Wurzburg, Dept Neurol, Wurzburg, Germany
Srikanth, V:
Monash Univ, Peninsula Clin Sch, Peninsula Hlth, Melbourne, Vic, Australia
Natl Ctr Hlth Ageing, Melbourne, Vic, Australia
Calvet, D:
St Anne Hosp, GHU Paris Psychiat & Neurosci, Dept Neurol, Paris, France
St Anne Hosp, GHU Paris Psychiat & Neurosci, Stroke Unit, Paris, France
Univ Paris Cite, INSERM, U1266, Inst Psychiat & Neurosci Paris, Paris, France
Jung, S:
Univ Bern, Univ Hosp Bern, Dept Neurol, Inselspital, Bern, Switzerland
Kwa, VIH:
OLVG, Dept Neurol, Amsterdam, Netherlands
Smith, EE:
Univ Calgary, Hotchkiss Brain Inst, Dept Clin Neurosci Radiol & Community Hlth Sci, Calgary Stroke Program, Calgary, AB, Canada
Hara, H:
Saga Univ, Dept Internal Med, Div Neurol, Fac Med, Saga, Japan
Yakushiji, Y:
Kansai Med Univ, Dept Neurol, Hirakata, Osaka, Japan
Orken, DN:
Istanbul Arel Univ, Dept Neurol, Istanbul, Turkiye
Fazekas, F:
Med Univ Graz, Dept Neurol, Graz, Austria
Thijs, V:
Univ Melbourne, Stroke Div, Florey Inst Neurosci & Mental Hlth, Heidelberg, Vic, Australia
Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurol, AA Martinos Ctr Biomed Imaging, Boston, MA USA
Harvard Med Sch, Massachusetts Gen Hosp, Dept Radiol, AA Martinos Ctr Biomed Imaging, Boston, MA USA
Heo, JH:
Yonsei Univ, Dept Neurol, Coll Med, Seoul, South Korea
Veltkamp, R:
Heidelberg Univ Hosp, Dept Neurol, Heidelberg, Germany
Austin Hlth, Dept Neurol, Heidelberg, Vic, Australia
Ay, H:
Imperial Coll London, Dept Brain Sci, London, England
Lau, KK:
Univ Hong Kong, Dept Med, Div Neurol, Hong Kong, Peoples R China
Univ Hong Kong, State Key Lab Brain & Cognit Sci, Shatin, Hong Kong, Peoples R China
Jouvent, E:
Univ Paris, AP HP, Paris, France
Hop Lariboisiere, Dept Neurol, FHU NeuroVasc, INSERM,NeuroDiderot U1141, Paris, France
Toyoda, K:
Natl Cerebral & Cardiovasc Ctr, Dept Cerebrovasc Med, Suita, Osaka, Japan
Yoshimura, S:
Natl Cerebral & Cardiovasc Ctr, Dept Cerebrovasc Med, Suita, Osaka, Japan
Bae, HJ:
Seoul Natl Univ, Coll Med, Bundang Hosp, Dept Neurol, Seongnam, South Korea
Marti-Fabregas, J:
Hosp Santa Creu & Sant Pau, Dept Neurol, Biomed Res Inst, Barcelona, Spain
Prats-Sanchez, L:
Hosp Santa Creu & Sant Pau, Dept Neurol, Biomed Res Inst, Barcelona, Spain
Lyrer, P:
Univ Hosp Basel, Dept Neurol, Basel, Switzerland
Univ Hosp Basel, Stroke Ctr, Basel, Switzerland
Univ Basel, Basel, Switzerland
Best, J:
UCL Queen Sq Inst Neurol, Dept Brain Repair & Rehabil, Stroke Res Ctr, London, England
Univ Coll London Hosp NHS Trust, Comprehens Stroke Serv, London, England
Werring, D:
UCL Queen Sq Inst Neurol, Dept Brain Repair & Rehabil, Stroke Res Ctr, London, England
Univ Coll London Hosp NHS Trust, Comprehens Stroke Serv, London, England
Engelter, ST:
Univ Hosp Basel, Dept Neurol, Basel, Switzerland
Univ Hosp Basel, Stroke Ctr, Basel, Switzerland
Univ Basel, Basel, Switzerland
Univ Basel, Univ Dept Geriatr Med FELIX PLATTER, Neurol & Neurorehabil, Basel, Switzerland
Peters, N:
Univ Hosp Basel, Dept Neurol, Basel, Switzerland
Univ Hosp Basel, Stroke Ctr, Basel, Switzerland
Univ Basel, Basel, Switzerland
Univ Basel, Univ Dept Geriatr Med FELIX PLATTER, Neurol & Neurorehabil, Basel, Switzerland
Stroke Ctr, Klin Hirslanden, Zurich, Switzerland
hybrid, Green Published, Green Accepted, All Open Access, Hybrid Gold, Green
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