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Microbleed prevalence and burden in anticoagulant-associated intracerebral bleed

Vasileios-Arsenios Lioutas1, Nitin Goyal2, Aristeidis H Katsanos3,4

  • 1Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Annals of Clinical and Translational Neurology
|August 13, 2019
PubMed

Insights

Nonvitamin K oral anticoagulants (NOACs) are associated with fewer cerebral microbleeds (CMBs) in patients experiencing intracerebral hemorrhage (ICH) compared to Vitamin K antagonists (VKAs). This finding suggests a potentially safer profile for NOACs regarding microhemorrhage burden.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Cerebral microbleeds (CMBs) are associated with anticoagulant use.
  • The association between nonvitamin K oral anticoagulants (NOACs) and CMBs is less understood than that for Vitamin K antagonists (VKAs).

Purpose of the Study:

  • To investigate and compare the cerebral microbleed (CMB) profiles in patients with anticoagulation-related intracerebral hemorrhage (ICH) treated with NOACs versus VKAs.

Main Methods:

  • Observational study of 89 patients with anticoagulation-related ICH across multiple centers.
  • Analysis of CMB prevalence and count in patients treated with NOACs compared to VKAs.
  • Multivariable logistic regression to adjust for potential confounding factors.

Main Results:

  • Overall CMB prevalence was 51% (52% in VKA-ICH, 48% in NOAC-ICH).
  • NOAC-ICH patients exhibited a significantly lower median CMB count (2 vs. 7; P < 0.001) and reduced prevalence of ≥5 CMBs (4% vs. 31%; P = 0.006).
  • An inverse association between NOAC use and high CMB count remained significant after multivariable adjustment (OR 0.10; P = 0.034).

Conclusions:

  • Nonvitamin K oral anticoagulants (NOACs) are associated with a lower burden of cerebral microbleeds (CMBs) in patients with intracerebral hemorrhage (ICH) compared to Vitamin K antagonists (VKAs).
  • These findings suggest NOACs may have a more favorable safety profile concerning microhemorrhagic changes in the brain.

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