MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation
- 21 May 2019
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 92 (21), e2432-e2443
- https://doi.org/10.1212/wnl.0000000000007532
Abstract
Objective We tested the hypothesis that the risk of intracranial hemorrhage (ICH) in patients with cardioembolic ischemic stroke who are treated with oral anticoagulants (OAs) can be predicted by evaluating surrogate markers of hemorrhagic-prone cerebral angiopathies using a baseline MRI. Methods Patients were participants in a multicenter and prospective observational study. They were older than 64 years, had a recent cardioembolic ischemic stroke, and were new users of OAs. They underwent a baseline MRI analysis to evaluate microbleeds, white matter hyperintensities, and cortical superficial siderosis. We collected demographic variables, clinical characteristics, risk scores, and therapeutic data. The primary endpoint was ICH that occurred during follow-up. We performed bivariate and multivariate Cox regression analyses. Results We recruited 937 patients (aged 77.6 ± 6.5 years; 47.9% were men). Microbleeds were detected in 207 patients (22.5%), moderate/severe white matter hyperintensities in 419 (45.1%), and superficial siderosis in 28 patients (3%). After a mean follow-up of 23.1 ± 6.8 months, 18 patients (1.9%) experienced an ICH. In multivariable analysis, microbleeds (hazard ratio 2.7, 95% confidence interval [CI] 1.1–7, p = 0.034) and moderate/severe white matter hyperintensities (hazard ratio 5.7, 95% CI 1.6–20, p = 0.006) were associated with ICH (C index 0.76, 95% CI 0.66–0.85). Rate of ICH was highest in patients with both microbleed and moderate/severe WMH (3.76 per 100 patient-years, 95% CI 1.62–7.4). Conclusion Patients taking OAs who have advanced cerebral small vessel disease, evidenced by microbleeds and moderate to severe white matter hyperintensities, had an increased risk of ICH. Our results should help to determine the risk of prescribing OA for a patient with cardioembolic stroke. ClinicalTrials.gov identifier NCT02238470.Keywords
This publication has 37 references indexed in Scilit:
- Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegenerationThe Lancet Neurology, 2013
- MRI Screening for Chronic Anticoagulation in Atrial FibrillationFrontiers in Neurology, 2013
- Risk of intraparenchymal hemorrhage with magnetic resonance imaging‐defined leukoaraiosis and brain infarctsAnnals of Neurology, 2011
- Antithrombotic Drug Use, Cerebral Microbleeds, and Intracerebral Hemorrhage A Systematic Review of Published and Unpublished StudiesStroke, 2010
- Cerebral microbleeds: a guide to detection and interpretationThe Lancet Neurology, 2009
- Cerebral microbleeds are a risk factor for warfarin-related intracerebral hemorrhageNeurology, 2009
- Spontaneous brain microbleeds: systematic review, subgroup analyses and standards for study design and reportingBrain, 2007
- Intracerebral Hemorrhage Associated With Oral Anticoagulant TherapyStroke, 2006
- Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non‐surgical patientsJournal of Thrombosis and Haemostasis, 2005
- Cerebral Microbleeds as a Risk Factor for Subsequent Intracerebral Hemorrhages Among Patients With Acute Ischemic StrokeStroke, 2003