Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation
Soo, Yannie (The Chinese University of Hong Kong (Hong Kong, Xina))
Zietz, Annaelle (University Hospital Basel (Basilea, Suïssa))
Yiu, Brian (The Chinese University of Hong Kong (Hong Kong, Xina))
Mok, Vincent C. T. (The Chinese University of Hong Kong (Hong Kong, Xina))
Polymeris, Alexandros A. (University Hospital Basel and University of Basel (Basel, Suïssa))
Seiffge, David (University of Bern (Bern, Suïssa))
Ambler, Gareth (University College London (Londres, Regne Unit))
Wilson, Duncan (New Zealand Brain Research Institute (Christchurch, Nova Zelanda))
Leung, Thomas Wai Hong (The Chinese University of Hong Kong (Hong Kong, Xina))
Tsang, Suk Fung (The Chinese University of Hong Kong (Hong Kong, Xina))
Chu, Winnie (The Chinese University of Hong Kong (Hong Kong, Xina))
Abrigo, Jill (The Chinese University of Hong Kong (Hong Kong, Xina))
Cheng, Cyrus (The Chinese University of Hong Kong (Hong Kong, Xina))
Lee, Keon-Joo (Korea University Guro Hospital (Seül, Corea del Sud))
Lim, Jae-Sung (University of Ulsan College of Medicine (Seül, Corea del Sud))
Shiozawa, Masayuki (National Cerebral and Cardiovascular Centre (Suita, Japó))
Koga, Masatoshi (National Cerebral and Cardiovascular Centre (Suita, Japó))
Chabriat, Hugues (Lariboisière Hospital (París, França))
Hennerici, Michael (University of Heidelberg/Mannheim Hospital (Mannheim , Alemanya))
Wong, Yuen Kwun (The University of Hong Kong (Hong Kong, Xina))
Mak, Henry (The University of Hong Kong (Hong Kong, Xina))
Collet Vidiella, Roger (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Inamura, Shigeru (Kushiro City General Hospital (Kushiro, Japó))
Yoshifuji, Kazuhisa (Kushiro City General Hospital (Kushiro, Japó))
Arsava, Ethem Murat (Massachusetts General Hospital (Boston, Estats Units d'Amèrica)))
Horstmann, Solveig (Heidelberg University Hospital (Alemanya))
Purrucker, Jan (Heidelberg University Hospital (Alemanya))
Lam, Bonnie Y. K. (The Chinese University of Hong Kong (Hong Kong, Xina))
Wong, Adrian (Margaret K. L. The Chinese University of Hong Kong (Hong Kong, Xina))
Kim, Young Dae (Yonsei University College of Medicine (Seül, Corea del Sud))
Song, Tae-Jin (Seoul Hospital. Ewha Womans University College of Medicine (Seül, Corea del Sud))
Lemmens, Robin (University Hospitals Leuven (Bèlgica))
Eppinger, Sebastian (Medical University of Graz (Graz, Àustria))
Gattringer, Thomas (Medical University of Graz (Graz, Àustria))
Uysal, Ender (University of Health Sciences Turkey (Antalya, Turquia))
Demirelli, Derya Selçuk (University of Health Sciences Turkey (Antalya, Turquia))
Bornstein, Natan M. (Tel Aviv University)
Assayag, Einor Ben (Tel Aviv University)
Hallevi, Hen (Tel Aviv University)
Molad, Jeremy (Tel Aviv University)
Nishihara, Masashi (Saga University Faculty of Medicine (Saga, Japó))
Tanaka, Jun (St. Mary's Hospital (Kurume, Japó))
Coutts, Shelagh B. (University of Calgary (Calgary, Canadà))
Kappelle, L. Jaap (University Medical Centre Utrecht and Utrecht University (Utrecht, Països Baixos))
Al-Shahi Salman, Rustam (University of Edinburgh (Edimburg, Escòcia))
Jäger, Hans Rolf (Lysholm UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery (Londres, Regne Unit))
Lip, Gregory Y. H. (Aalborg University (Aalborg, Dinamarca))
Goeldlin, Martina (University of Bern (Bern, Suïssa))
Panos, Leonidas (University of Bern (Bern, Suïssa))
Mas, Jean-Louis (Institute of Psychiatry and Neuroscience of Paris (París, França))
Legrand, Laurence (Institute of Psychiatry and Neuroscience of Paris (París, França))
Karayiannis, Christopher Charles (Monash University (Melbourne, Austràlia))
Phan, Thanh (Monash University (Melbourne, Austràlia))
Bellut, Maximilian (University Hospital of Würzburg (Würzburg, Alemanya))
Chappell, Francesca (UK Dementia Institute at the University of Edinburgh (Edimburg, Escòcia))
Makin, Stephen (University of Aberdeen (Aberdeen, Regne Unit))
Hayden, Derek (Tallaght University Hospital (Dublín, Irlanda))
Williams, David (Ireland and Beaumont Hospital Dublin (Dublín, Irlanda))
van Dam-Nolen, Dianne H. K. (Erasmus University Medical Center Rotterdam (Països Baixos))
Nederkoorn, Paul J. (Amsterdam University Medical Center (UMC))
Barbato, Carmen (Università degli Studi di Firenze)
Browning, Simone (University College London Hospitals NHS Trust (Londres, Regne Unit))
Wiegertjes, Kim (Radboud University Medical Centre (Nijmegen, Països Baixos))
Tuladhar, Anil M. (Radboud University Medical Centre (Nijmegen, Països Baixos))
Mendyk, Anne-Marie (University of Lille (Lille, França))
Köhler, Sebastian (Maastricht University (Maastricht, Països Baixos))
van Oostenburgge, Robert (Maastricht University Medical Centre (Maastricht, Països Baixos))
Zhou, Ying (The Second Affiliated Hospital of Zhejiang University (Hangzhou, Xina))
Xu, Chao (The Second Affiliated Hospital of Zhejiang University (Hangzhou, Xina))
Hilal, Saima (National University of Singapore and National University Health System (Singapur))
Gyanwali, Bibek (National University of Singapore (Singapur))
Chen, Christopher (National University of Singapore (Singapur))
Lou, Min (The Second Affiliated Hospital of Zhejiang University (Hangzhou, Xina))
Staals, Julie (Maastricht University Medical Centre (Maastricht, Països Baixos))
Bordet, Régis (University of Lille (Lille, França))
Kandiah, Nagaendran (Lee Kong Chian School of Medicine)
de Leeuw, Frank-Erik (Radboud University Medical Centre (Nijmegen, Països Baixos))
Simister, Robert (University College London Hospitals NHS Trust (Londres, Regne Unit))
Hendrikse, Jeroen (University Medical Center Utrecht (Utrecht, Països Baixos))
Wardlaw, Joanna (University of Edinburgh and NHS Lothian (Edimburg, Escòcia))
Kelly, Peter (University College Dublin (Dublín, Irlanda))
Fluri, Felix (University Hospital of Würzburg (Würzburg, Alemanya))
Srikanth, Velandai (National Centre for Healthy Ageing (Melbourne, Austràlia))
Calvet, David (Institute of Psychiatry and Neuroscience of Paris (París, França))
Jung, Simon (University of Bern (Bern, Suïssa))
Kwa, Vincent I. H. (Onze Lieve Vrouwe Gasthuis (Amsterdam, Països Baixos))
Smith, Eric E. (University of Calgary (Calgary, Canadà))
Hara, Hideo (Saga University Faculty of Medicine (Saga, Japó))
Yakushiji, Yusuke (Kansai Medical University (Hirakata, Japó))
Orken, Dilek Necioglu (Istanbul Arel University (Istanbul, Turquia))
Fazekas, Franz (Medical University of Graz (Graz, Àustria))
Thijs, Vincent (Harvard Medical School)
Heo, Ji Hoe (Yonsei University College of Medicine (Seül, Corea del Sud))
Veltkamp, Roland (Austin Health (Heidelberg, Austràlia))
Ay, Hakan (Imperial College London (Londres, Regne Unit))
Imaizumi, Toshio (Kushiro City General Hospital (Japó))
Lau, Kui Kai (The University of Hong Kong)
Jouvent, Eric (INSERM NeuroDiderot U1141 (França))
Toyoda, Kazunori (National Cerebral and Cardiovascular Centre (Japó))
Yoshimura, Sohei (National Cerebral and Cardiovascular Centre (Japó))
Bae, Hee-Joon (Seoul National University College of Medicine (Corea del Sud))
Martí-Fàbregas, Joan (Institut d'Investigació Biomèdica Sant Pau)
Prats-Sánchez, Luis Antonio (Institut d'Investigació Biomèdica Sant Pau)
Lyrer, Philippe (University Hospital Basel and University of Basel (Basel, Suïssa))
Best, Jonathan (University College London Hospitals NHS Trust (Londres, Regne Unit))
Werring, David (University College London Hospitals NHS Trust (Londres, Regne Unit))
Engelter, Stefan (University of Basel (Suïssa))
Peters, Nils (Klinik Hirslanden (Zürich, Suïssa))
Universitat Autònoma de Barcelona

Data:	2023
Resum:	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). 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. 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). 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	Annals of neurology, Vol. 94 Núm. 1 (july 2023) , p. 61-74, ISSN 1531-8249

DOI: 10.1002/ana.26642
PMID: 36928609

14 p, 978.5 KB

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