Brain microbleeds, anticoagulation, and hemorrhage risk Meta-analysis in stroke patients with AF
- 주제(기타) Clinical Neurology
- 설명문(일반) [Charidimou, Andreas] Massachusetts Gen Hosp, Dept Neurol, J Philip Kistler Stroke Res Ctr, Boston, MA 02114 USA; [Charidimou, Andreas] Harvard Med Sch, Boston, MA 02115 USA; [Charidimou, Andreas] META MICROBLEEDS Initiat Consortium, Melbourne, Vic, Australia; [Karayiannis, Christopher; Goh, Su Mei; Phan, Thanh G.; Chandra, Ronil V.; Srikanth, Velandai] Monash Univ, Monash Hlth, Stroke & Ageing Res Ctr, Dept Med,Sch Clin Sci, Melbourne, Vic, Australia; [Heo, Ji Hoe] Yonsei Univ, Coll Med, Dept Neurol, Seoul, South Korea; [Orken, Dilek Necioglu] Sisli Hamidiye Etfal Educ & Res Hosp, Dept Neurol, Istanbul, Turkey; [Thijs, Vincent] Austin Hlth, Dept Neurol, Heidelberg, Vic, Australia; Florey Inst Neurosci & Mental Hlth, Heidelberg, Vic, Australia; [Kim, Jinkwon] CHA Univ, CHA Bundang Med Ctr, Dept Neurol, Seongnam, South Korea; [Phan, Thanh G.; Srikanth, Velandai] Monash Hlth, Stroke Unit, Melbourne, Vic, Australia; [Soufan, Cathy; Chandra, Ronil V.; Slater, Lee-Anne] Monash Hlth, Monash Imaging, Neurosci, Melbourne, Vic, Australia; [Soufan, Cathy; Chandra, Ronil V.; Slater, Lee-Anne] Monash Hlth, Monash Imaging, Serv Neuroradiol, Melbourne, Vic, Australia; [Haji, Shamir] Mayo Clin, Dept Neurol, Rochester, MN USA; [Mok, Vincent; Leung, Kam Tat; Wong, Lawrence K. S.; Soo, Yannie] Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China; [Veltkamp, Roland; Imaizumi, Toshio] Heidelberg Univ, Dept Neurol, Heidelberg, Germany; [Kawamura, Yuichiro; Sato, Nobuyuki; Hasebe, Naoyuki; Saito, Tsukasa] Asahikawa Med Univ, Cardiovasc Resp & Neurol Div, Dept Internal Med, Asahikawa, Hokkaido, Japan; [Veltkamp, Roland] Imperial Coll London, Dept Stroke Med, Div Brain Sci, London, England; [Flemming, Kelly D.] Kushiro City Gen Hosp, Dept Neurosurg, Kushiro, Hokkaido, Japan; [Lemmens, Robin] KU Leuven Univ Leuven, Dept Neurosci, Expt Neurol, Leuven, Belgium; Leuven Res Inst Neurosci & Dis, Leuven, Belgium; [Lemmens, Robin] VIB, Vesalius Res Ctr, Lab Neurobiol, Leuven, Belgium; [Lemmens, Robin] Univ Hosp Leuven, Dept Neurol, Leuven, Belgium; [Song, Tae-Jin] Ewha Womans Univ, Coll Med, Dept Neurol, Seoul, South Korea
- 등재 SCIE, SCOPUS
- 발행기관 LIPPINCOTT WILLIAMS & WILKINS
- 발행년도 2017
- URI http://www.dcollection.net/handler/ewha/000000149961
- 본문언어 영어
- Published As http://dx.doi.org/10.1212/WNL.0000000000004704
초록/요약
Objectives: To assess the association between cerebral microbleeds (CMBs) and future spontaneous intracerebral hemorrhage (ICH) risk in ischemic stroke patients with nonvalvular atrial fibrillation (AF) taking oral anticoagulants. Methods: This was a meta-analysis of cohort studies with.50 patients with recent ischemic stroke and documented AF, brain MRI at baseline, long-term oral anticoagulation treatment, and >= 6 months of follow-up. Authors provided summary-level data on stroke outcomes stratified by CMB status. We estimated pooled annualized ICH and ischemic stroke rates from Poisson regression. We calculated odds ratios (ORs) of ICH by CMB presence/absence, >= 5 CMBs, and CMB topography (strictly lobar, mixed, and strictly deep) using random-effects models. Results: We established an international collaboration and pooled data from 8 centers including 1,552 patients. The crude CMB prevalence was 30% and 7% for >= 5 CMBs. Baseline CMB presence (vs no CMB) was associated with ICH during follow-up (OR 2.68, 95% confidence interval [CI] 1.19-6.01, p = 0.017). Presence of >= 5 CMB was related to higher future ICH risk (OR 5.50, 95% CI 2.07-14.66, p = 0.001). The pooled annual ICH incidence increased from 0.30% (95% CI 0.04-0.55) among CMB-negative patients to 0.81% (95% CI 0.17-1.45) in CMB-positive patients (p = 0.01) and 2.48% (95% CI 1.2-6.2) in patients with >= 5 CMBs (p = 0.001). There was no association between CMBs and recurrent ischemic stroke. Conclusions: The presence of CMB on MRI and the dichotomized cutoff of >= 5 CMBs might identify subgroups of ischemic stroke patients with AF with high ICH risk and after further validation could help in risk stratification, in anticoagulation decisions, and in guiding randomized trials and ongoing large observational studies.
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