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MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation

Joan Martí-Fàbregas1, Santiago Medrano-Martorell2, Elisa Merino2

  • 1From the Department of Neurology (J.M.-F., L.P.-S., R.M., R.D.-M., A.M.-D., P.C.-R., E.J.-X.) and Epidemiology (I.G.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona; Departments of Radiology (S.M.-M.) and Neurology (A.R.-C.), Hospital del Mar-Parc de Salut Mar, Barcelona; Unitat RM IDI (E.M.) and Department of Neurosciences (M.H.-P.), Hospital Germans Trias i Pujol, Badalona; Department of Neurology (M.Z.), Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy; Department of Neurology (M.G.-C.), Hospital de Sant Joan Despí Moises Broggi, Sant Joan Despí, Spain; Department of Neurology (L. Lara), Hospital de León; Department of Neurology (A.B.), Hospital Universitari Son Espases, Palma de Mallorca; Department of Neurology (A.C.), Hospital de Valladolid; Department of Neurology (A.M.D.A.-B.), Hospital de Donostia; Department of Neurology (Y.B.), Hospital de Burgos; Department of Neurology (B.F.), Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPaz, Madrid; Department of Neurology (D. Cánovas), Hospital Parc Taulí, Sabadell; Department of Neurology (L. Llull), Hospital Clínic, Barcelona; Department of Neurology (B.Z.), Hospital de Navarra, Pamplona; Department of Neurology (M.F.), Hospital de Basurto, Bilbao; Department of Neurology (I.C.-N.), Hospital San Pedro de Alcántara, Cáceres; Department of Neurology (J.S.), Hospital Arnau de Vilanova, Lleida; Department of Neurology (D. Cocho), Hospital de Granollers; Department of Neurology (J.K.), F.Ass. Mutua Terrassa; Department of Neurology (E.P.), Hospital de Mataró; Department of Neurology (A.D.F.), Hospital Ramón y Cajal, Madrid; Department of Neurology (M.S.), Hospital La Rioja, Logroño; Department of Neurology (E.Z.-A.), Hospital Virgen del Rocío, Sevilla; Department of Neurology (J.Z.-B.), Hospital Verge de la Cinta, Tortosa; Department of Neurology (I.D.-M.), Hospital de Albacete; Department of Neurology (J.F.-D.), Centro Médico Asturias, Oviedo; Department of Neurology (A.L.), Hospital La Fe, Valencia; Department of Neurology (J.M.), Hospital Virgen de las Nieves, Granada; and Department of Neurology (M.R.-Y.), Hospital Santiago de Compostela, Santiago de Compostela, Spain. jmarti@santpau.cat.

Neurology
|April 21, 2019
PubMed
Abstract

Insights

Patients with cardioembolic stroke on oral anticoagulants (OAs) with microbleeds and white matter hyperintensities on MRI face a higher risk of intracranial hemorrhage (ICH). These findings aid in assessing OA prescription risks.

Area of Science:

  • Neurology
  • Radiology
  • Cardiology

Background:

  • Cardioembolic ischemic stroke patients on oral anticoagulants (OAs) face risks of intracranial hemorrhage (ICH).
  • Predicting ICH risk is crucial for safe OA prescription in this population.
  • Cerebral small vessel disease markers on MRI may indicate hemorrhagic risk.

Purpose of the Study:

  • To test if baseline MRI markers of hemorrhagic-prone cerebral angiopathies can predict ICH risk in patients with cardioembolic ischemic stroke treated with OAs.
  • To evaluate the association between MRI findings and subsequent ICH events.

Main Methods:

  • Prospective observational study of 937 patients (>64 years) with recent cardioembolic ischemic stroke, new OA users.
  • Baseline MRI assessed microbleeds, white matter hyperintensities (WMH), and superficial siderosis.
  • Multivariate Cox regression analyzed ICH as the primary endpoint over a mean follow-up of 23.1 months.

Main Results:

  • ICH occurred in 1.9% of patients during follow-up.
  • Microbleeds (HR 2.7) and moderate/severe WMH (HR 5.7) were significantly associated with increased ICH risk.
  • Patients with both microbleeds and moderate/severe WMH had the highest ICH rate (3.76 per 100 patient-years).

Conclusions:

  • Advanced cerebral small vessel disease, indicated by microbleeds and moderate/severe WMH on MRI, increases ICH risk in OA-treated cardioembolic stroke patients.
  • These MRI markers can inform risk-benefit assessments for OA therapy.
  • Baseline MRI findings are valuable for personalized risk stratification in stroke patients.

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