Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation

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 WongHenry 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 Selcuk 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, Microbleeds International Collaborative Network, Sebastian Kohler, Julie Staals, Nils Peters*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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.
Original languageEnglish
Pages (from-to)61-74
Number of pages14
JournalAnnals of Neurology
Volume94
Issue number1
Early online date1 Apr 2023
DOIs
Publication statusPublished - 1 Jul 2023

Keywords

  • TRANSIENT ISCHEMIC ATTACK
  • SMALL-VESSEL DISEASE
  • INTRACEREBRAL HEMORRHAGE
  • RISK
  • MRI
  • WARFARIN
  • METAANALYSIS
  • INFARCTION
  • THERAPY
  • COHORT

Fingerprint

Dive into the research topics of 'Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation'. Together they form a unique fingerprint.

Cite this