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Use of anticoagulant therapy and cerebral microbleeds: a systematic review and meta-analysis
Yajun Cheng1, Yanan Wang1, Quhong Song1
1Department of Neurology, Center of Cerebrovascular Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
Background:
Anticoagulant therapy increases the risk that cerebral microbleeds (CMBs) progress to intracerebral hemorrhage, but whether the therapy increases risk of CMB occurrence is unclear. We performed a systematic review and meta-analysis to investigate the potential association between anticoagulant use and CMB occurrence in stroke and stroke-free individuals.
Methods:
We searched observational studies in PubMed, Ovid EMBASE, and Cochrane Library from their inception until September 2019. We calculated the pooled odds ratio (OR) and 95% confidence interval (CI) for the prevalence and incidence of CMBs in anticoagulant users relative to non-anticoagulant users.
Results:
Forty-seven studies with 25,245 participants were included. The pooled analysis showed that anticoagulant use was associated with CMB prevalence (OR 1.54, 95% CI 1.26-1.88). The association was observed in subgroups stratified by type of participants: stroke-free, OR 1.86, 95% CI 1.25-2.77; ischemic stroke/transient ischemic attack, OR 1.33, 95% CI 1.06-1.67; and intracerebral hemorrhage, OR 2.26, 95% CI 1.06-4.83. Anticoagulant use was associated with increased prevalence of strictly lobar CMBs (OR 1.68, 95% CI 1.22-2.32) but not deep/infratentorial CMBs. Warfarin was associated with increased CMB prevalence (OR 1.64, 95% CI 1.23-2.18), but novel oral anticoagulants were not. Anticoagulant users showed higher incidence of CMBs during long-term follow-up (OR 1.72, 95% CI 1.22-2.44).
Conclusion:
Anticoagulant use is associated with higher prevalence and incidence of CMBs. This association appears to depend on location of CMBs and type of anticoagulants. More longitudinal investigations with adjustment for confounders are required to establish the causality.
Insights
Anticoagulant use is linked to a higher prevalence and incidence of cerebral microbleeds (CMBs). This association varies by CMB location and anticoagulant type, suggesting further research is needed.
Area of Science:
- Neurology
- Pharmacology
- Epidemiology
Background:
- Anticoagulant therapy elevates the risk of cerebral microbleed (CMB) progression to intracerebral hemorrhage.
- The impact of anticoagulant use on the initial occurrence of CMBs remains unclear.
Purpose of the Study:
- To systematically review and meta-analyze observational studies investigating the association between anticoagulant use and CMB occurrence.
- To assess CMB prevalence and incidence in both stroke and stroke-free individuals using anticoagulant therapy.
Main Methods:
- A systematic search of PubMed, Ovid EMBASE, and Cochrane Library was conducted up to September 2019.
- Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated for CMB prevalence and incidence in anticoagulant users versus non-users.
Main Results:
- Forty-seven studies comprising 25,245 participants were analyzed.
- Anticoagulant use was associated with increased CMB prevalence (OR 1.54, 95% CI 1.26-1.88) and incidence (OR 1.72, 95% CI 1.22-2.44).
- Associations varied by participant group, CMB location (lobar vs. deep), and anticoagulant type (warfarin vs. novel oral anticoagulants).
Conclusions:
- Anticoagulant use is associated with a higher prevalence and incidence of cerebral microbleeds.
- The relationship is influenced by the location of CMBs and the specific type of anticoagulant used.
- Further longitudinal studies adjusting for confounders are necessary to establish causality.
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