Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation
Yannie Soo
(1, 2, 3)
,
Annaelle Zietz
(4, 3)
,
Brian Yiu
(1, 2)
,
Vincent C T Mok
(1, 2, 5)
,
Alexandros A Polymeris
(4, 3)
,
David Seiffge
(6, 7)
,
Gareth Ambler
(8)
,
Duncan Wilson
(9, 10, 11)
,
Thomas Wai Hong Leung
(1, 2)
,
Suk Fung Tsang
(1, 2)
,
Winnie Chu
(1, 2)
,
Jill Abrigo
(1, 2)
,
Cyrus Cheng
(1, 2)
,
Keon‐joo Lee
(12)
,
Jae‐sung Lim
(13, 14)
,
Masayuki Shiozawa
(15)
,
Masatoshi Koga
(15)
,
Hugues Chabriat
(16, 17, 18)
,
Michael Hennerici
(19, 20)
,
Yuen Kwun Wong
(21)
,
Henry Mak
(21)
,
Roger Collet
(22, 23)
,
Shigeru Inamura
(24)
,
Kazuhisa Yoshifuji
(24)
,
Ethem Murat Arsava
(25, 26)
,
Solveig Horstmann
(27)
,
Jan Purrucker
(27)
,
Bonnie y K Lam
(1, 2, 5)
,
Adrian Wong
(5)
,
Young Dae Kim
(28)
,
Tae‐jin Song
(29)
,
Robin Lemmens
(30, 31, 32)
,
Sebastian Eppinger
(33)
,
Thomas Gattringer
(33)
,
Ender Uysal
(34, 35)
,
Derya Selçuk Demirelli
(35, 36)
,
Natan M Bornstein
(37, 38)
,
Einor Ben Assayag
(37, 38)
,
Hen Hallevi
(37, 38)
,
Jeremy Molad
(37, 38)
,
Masashi Nishihara
(39)
,
Jun Tanaka
(40)
,
Shelagh B Coutts
(41, 42)
,
L. Jaap Kappelle
(43, 44)
,
Rustam Al‐shahi Salman
(45, 46)
,
Rolf Jager
(10, 47)
,
Gregory y H Lip
(48, 49, 50)
,
Martina B Goeldlin
,
Leonidas D Panos
,
Jean‐louis Mas
(51)
,
Laurence Legrand
(51, 52, 53)
,
Chris Karayiannis
(54)
,
Thanh Phan
(54)
,
Maximilian Bellut
(55)
,
Francesca Chappell
(46)
,
Stephen Makin
(56)
,
Derek Hayden
(57)
,
David Williams
(58, 59)
,
Dianne H K van Dam‐nolen
(60)
,
Paul J Nederkoorn
(61)
,
Carmen Barbato
(62)
,
Simone Browning
(10, 63)
,
Kim Wiegertjes
(64)
,
Anil Man Tuladhar
(64)
,
Anne‐marie Mendyk
(65, 66)
,
Sebastian Köhler
(67)
,
Robert van Oostenburgge
(68, 67)
,
Ying Zhou
(69)
,
Chao Xu
(69)
,
Saima Hilal
(70)
,
Bibek Gyanwali
(71, 70)
,
Christopher Chen
(71, 70)
,
Min Lou
(69)
,
Julie Staals
(68, 67)
,
Regis Bordet
(66, 65, 72)
,
Nagaendran Kandiah
(73)
,
Frank‐erik de Leeuw
(64)
,
Robert Simister
(10, 63)
,
Jeroen Hendrikse
(43)
,
Joanna Wardlaw
(46, 74)
,
Peter Kelly
(75)
,
Felix Fluri
(55)
,
Velandai Srikanth
(54)
,
David Calvet
(52, 51, 53)
,
Simon Jung
(7, 6)
,
Vincent, I H Kwa
(76)
,
Eric E Smith
(42)
,
Hideo Hara
(39)
,
Yusuke Yakushiji
(77)
,
Dilek Necioglu Orken
(78)
,
Franz Fazekas
(33)
,
Vincent Thijs
(79, 25, 26)
,
Ji‐hoe Heo
(28)
,
Roland Veltkamp
(27)
,
Hakan Ay
(80)
,
Toshio Imaizumi
(24)
,
Kui Kai Lau
(21)
,
Eric Jouvent
(17, 18, 16)
,
Kazunori Toyoda
(15)
,
Sohei Yoshimura
(15)
,
Hee‐joon Bae
(81)
,
Joan Martí‐fàbregas
(22)
,
Luis Prats‐sánchez
(22)
,
Philippe Lyrer
(4, 3)
,
Jonathan Best
(10, 63)
,
David Werring
(10, 63)
,
Stefan T Engelter
(4, 3)
,
Nils Peters
(82, 4, 3)
1
Prince of Wales Hospital
2 CUHK - The Chinese University of Hong Kong [Hong Kong]
3 Unibas - Université de Bâle = University of Basel = Basel Universität
4 University Hospital Basel [Basel]
5 GCNI - Gerald Choa Neuroscience Institute
6 Inselspital - Bern University Hospital [Berne]
7 UNIBE - Universität Bern = University of Bern = Université de Berne
8 UCL - University College of London [London]
9 Department of Brain Repair and Rehabilitation - Stroke Research Group [London, UK]
10 UCL Queen Square Institute of Neurology
11 NZBRI - New Zealand Brain Research Institute
12 KUGH - Korea University Guro Hospital [ Seoul, Republic of Korea]
13 Asan Medical Center [Seoul]
14 UUCM - University of Ulsan- College of Medicine [Ulsan, Republic of Korea]
15 N3C - Suita - National Cerebral and Cardiovascular Center [Osaka, Japon]
16 Hôpital Lariboisière-Fernand-Widal [APHP]
17 GHU-PPN - FHU NeuroVasc [Site Sainte-Anne, Paris]
18 NeuroDiderot (UMR_S_1141 / U1141) - Maladies neurodéveloppementales et neurovasculaires
19 University of Heidelberg, Medical Faculty
20 University Hospital Mannheim | Universitätsmedizin Mannheim
21 HKU - The University of Hong Kong
22 Hospital de la Santa Creu i Sant Pau
23 Vall Hebron Research Institute - Biomedical Research Group in Gynecology [Barcelona, Spain]
24 KCGH - Kushiro City General Hospital [Kushiro, Japon]
25 Massachusetts General Hospital [Boston]
26 HMS - Harvard Medical School [Boston]
27 Heidelberg University Hospital [Heidelberg]
28 Yonsei University
29 EWUMC - EWHA WOMANS UNIVERSITY MEDICAL CENTER [Seoul, Republic of Korea]
30 VIB Center for Brain & Disease Research [Leuven, Belgium]
31 KU Leuven - Catholic University of Leuven = Katholieke Universiteit Leuven
32 University Hospitals Leuven [Leuven]
33 Medical University of Graz = Medizinische Universität Graz
34 Antalya Education and Research Hospital [Antalya, Turkey]
35 University of Health Sciences [Istanbul, Turkey]
36 Şişli Hamidiye Etfal Training and Research Hospital [Istanbul, Turkey]
37 Tel Aviv Sourasky Medical Center [Tel Aviv]
38 TAU - Tel Aviv University
39 Saga University [Japon]
40 St. Mary's Hospital [Fukuoka, Japan]
41 Department of Clinical Neurosciences and Hotchkiss Brain Institute [Calgary, Canada]
42 University of Calgary
43 UMCU - University Medical Center [Utrecht]
44 Universiteit Utrecht / Utrecht University [Utrecht]
45 CCBS - Centre For Clinical Brain Sciences - Neuroimaging Sciences [Edinburgh, U.K.]
46 Edin. - University of Edinburgh
47 National Hospital for Neurology and Neurosurgery [London, UK]
48 University of Liverpool
49 LJMU - Liverpool John Moores University
50 LH&CH - Liverpool Heart and Chest Hospital NHS Trust [UK]
51 IPNP - U1266 Inserm - Institut de psychiatrie et neurosciences de Paris
52 GHU Paris Psychiatrie et Neurosciences
53 Centre Hospitalier Sainte Anne [Paris]
54 Monash University [Melbourne]
55 University Hospital of Würzburg
56 University of Aberdeen
57 TUH - Tallaght University Hospital [Dublin, Ireland]
58 RCSI - Royal College of Surgeons in Ireland
59 HB - Hôpital de Beaumont [Dublin, Ireland]
60 Erasmus MC - Erasmus University Medical Center [Rotterdam]
61 Amsterdam UMC - Amsterdam University Medical Centers
62 UniFI - Università degli Studi di Firenze = University of Florence = Université de Florence
63 UCLH - University College London Hospitals NHS Foundation Trust [London, UK]
64 Radboud University Medical Center [Nijmegen]
65 Troubles cognitifs vasculaires et dégénératifs
66 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
67 MUMC - Maastricht University Medical Centre
68 CARIM - Cardiovascular Research Institute Maastricht
69 Zhejiang University [Hangzhou, China]
70 NUS - National University of Singapore
71 Yong Loo Lin School of Medicine [Singapore]
72 LilNCog - Lille Neurosciences & Cognition - U 1172
73 Lee Kong Chian School of Medicine
74 NHSL - NHS Lothian [Edinburgh, Scotland]
75 UCD - University College Dublin [Dublin]
76 OLVG Hospital
77 Kansai University
78 Istanbul Arel University
79 University of Melbourne
80 Imperial College London
81 SNUCM - Seoul National University College of Medicine [Séoul, Corée du Sud]
82 Hirnschlagzentrum - Stroke center [Hôpital de Bâle]
2 CUHK - The Chinese University of Hong Kong [Hong Kong]
3 Unibas - Université de Bâle = University of Basel = Basel Universität
4 University Hospital Basel [Basel]
5 GCNI - Gerald Choa Neuroscience Institute
6 Inselspital - Bern University Hospital [Berne]
7 UNIBE - Universität Bern = University of Bern = Université de Berne
8 UCL - University College of London [London]
9 Department of Brain Repair and Rehabilitation - Stroke Research Group [London, UK]
10 UCL Queen Square Institute of Neurology
11 NZBRI - New Zealand Brain Research Institute
12 KUGH - Korea University Guro Hospital [ Seoul, Republic of Korea]
13 Asan Medical Center [Seoul]
14 UUCM - University of Ulsan- College of Medicine [Ulsan, Republic of Korea]
15 N3C - Suita - National Cerebral and Cardiovascular Center [Osaka, Japon]
16 Hôpital Lariboisière-Fernand-Widal [APHP]
17 GHU-PPN - FHU NeuroVasc [Site Sainte-Anne, Paris]
18 NeuroDiderot (UMR_S_1141 / U1141) - Maladies neurodéveloppementales et neurovasculaires
19 University of Heidelberg, Medical Faculty
20 University Hospital Mannheim | Universitätsmedizin Mannheim
21 HKU - The University of Hong Kong
22 Hospital de la Santa Creu i Sant Pau
23 Vall Hebron Research Institute - Biomedical Research Group in Gynecology [Barcelona, Spain]
24 KCGH - Kushiro City General Hospital [Kushiro, Japon]
25 Massachusetts General Hospital [Boston]
26 HMS - Harvard Medical School [Boston]
27 Heidelberg University Hospital [Heidelberg]
28 Yonsei University
29 EWUMC - EWHA WOMANS UNIVERSITY MEDICAL CENTER [Seoul, Republic of Korea]
30 VIB Center for Brain & Disease Research [Leuven, Belgium]
31 KU Leuven - Catholic University of Leuven = Katholieke Universiteit Leuven
32 University Hospitals Leuven [Leuven]
33 Medical University of Graz = Medizinische Universität Graz
34 Antalya Education and Research Hospital [Antalya, Turkey]
35 University of Health Sciences [Istanbul, Turkey]
36 Şişli Hamidiye Etfal Training and Research Hospital [Istanbul, Turkey]
37 Tel Aviv Sourasky Medical Center [Tel Aviv]
38 TAU - Tel Aviv University
39 Saga University [Japon]
40 St. Mary's Hospital [Fukuoka, Japan]
41 Department of Clinical Neurosciences and Hotchkiss Brain Institute [Calgary, Canada]
42 University of Calgary
43 UMCU - University Medical Center [Utrecht]
44 Universiteit Utrecht / Utrecht University [Utrecht]
45 CCBS - Centre For Clinical Brain Sciences - Neuroimaging Sciences [Edinburgh, U.K.]
46 Edin. - University of Edinburgh
47 National Hospital for Neurology and Neurosurgery [London, UK]
48 University of Liverpool
49 LJMU - Liverpool John Moores University
50 LH&CH - Liverpool Heart and Chest Hospital NHS Trust [UK]
51 IPNP - U1266 Inserm - Institut de psychiatrie et neurosciences de Paris
52 GHU Paris Psychiatrie et Neurosciences
53 Centre Hospitalier Sainte Anne [Paris]
54 Monash University [Melbourne]
55 University Hospital of Würzburg
56 University of Aberdeen
57 TUH - Tallaght University Hospital [Dublin, Ireland]
58 RCSI - Royal College of Surgeons in Ireland
59 HB - Hôpital de Beaumont [Dublin, Ireland]
60 Erasmus MC - Erasmus University Medical Center [Rotterdam]
61 Amsterdam UMC - Amsterdam University Medical Centers
62 UniFI - Università degli Studi di Firenze = University of Florence = Université de Florence
63 UCLH - University College London Hospitals NHS Foundation Trust [London, UK]
64 Radboud University Medical Center [Nijmegen]
65 Troubles cognitifs vasculaires et dégénératifs
66 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
67 MUMC - Maastricht University Medical Centre
68 CARIM - Cardiovascular Research Institute Maastricht
69 Zhejiang University [Hangzhou, China]
70 NUS - National University of Singapore
71 Yong Loo Lin School of Medicine [Singapore]
72 LilNCog - Lille Neurosciences & Cognition - U 1172
73 Lee Kong Chian School of Medicine
74 NHSL - NHS Lothian [Edinburgh, Scotland]
75 UCD - University College Dublin [Dublin]
76 OLVG Hospital
77 Kansai University
78 Istanbul Arel University
79 University of Melbourne
80 Imperial College London
81 SNUCM - Seoul National University College of Medicine [Séoul, Corée du Sud]
82 Hirnschlagzentrum - Stroke center [Hôpital de Bâle]
Yannie Soo
- Fonction : Auteur
- PersonId : 1259709
- ORCID : 0000-0002-3489-3201
Annaelle Zietz
- Fonction : Auteur
- PersonId : 1259710
- ORCID : 0000-0002-4362-2497
Brian Yiu
- Fonction : Auteur
Alexandros A Polymeris
- Fonction : Auteur
- PersonId : 1259711
- ORCID : 0000-0002-9475-2208
David Seiffge
- Fonction : Auteur
- PersonId : 808764
- ORCID : 0000-0003-3890-3849
Masatoshi Koga
- Fonction : Auteur
- PersonId : 1259712
- ORCID : 0000-0002-6758-4026
Hugues Chabriat
- Fonction : Auteur
- PersonId : 1163170
- ORCID : 0000-0001-8436-6074
- IdRef : 060577304
Thomas Gattringer
- Fonction : Auteur
- PersonId : 1248659
- ORCID : 0000-0002-6065-6576
Martina B Goeldlin
- Fonction : Auteur
- PersonId : 1259714
- ORCID : 0000-0001-5800-116X
Leonidas D Panos
- Fonction : Auteur
Kim Wiegertjes
- Fonction : Auteur
- PersonId : 1259715
- ORCID : 0000-0001-7480-1482
Anil Man Tuladhar
- Fonction : Auteur
- PersonId : 1259716
- ORCID : 0000-0002-4815-2834
Ying Zhou
- Fonction : Auteur
- PersonId : 1259717
- ORCID : 0000-0003-3577-4527
Nagaendran Kandiah
- Fonction : Auteur
- PersonId : 1259718
- ORCID : 0000-0001-9244-4298
Joanna Wardlaw
- Fonction : Auteur
- PersonId : 1259719
- ORCID : 0000-0002-9812-6642
Eric Jouvent
- Fonction : Auteur
- PersonId : 1163169
- ORCID : 0000-0001-7797-2236
- IdRef : 117664359
Kazunori Toyoda
- Fonction : Auteur
- PersonId : 1259721
- ORCID : 0000-0002-8346-9845
Sohei Yoshimura
- Fonction : Auteur
- PersonId : 1259722
- ORCID : 0000-0002-4751-3538
Joan Martí‐fàbregas
- Fonction : Auteur
- PersonId : 1259723
- ORCID : 0000-0001-9229-8649
Résumé
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.
Domaines
Médecine humaine et pathologie| Origine | Publication financée par une institution |
|---|---|
| Licence |
