Microbleeds and Outcome in Patients With Acute Ischemic Stroke and Atrial Fibrillation Taking Anticoagulants

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Kang-Ho Choi1,2, Ja-Hae Kim3, Changho Lee4

  • 1Department of Neurology (K.-H. Choi, J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H. Cho), Chonnam National University Medical School and Hospital, Gwangju, Korea.

Stroke
|October 8, 2020
PubMed
Abstract

Insights

The number of cerebral microbleeds (CMBs) significantly increases the risk of major adverse cerebrovascular and cardiovascular events (MACCE) in stroke patients on anticoagulants. CMB location did not affect risk, which was higher with warfarin.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Cerebral microbleeds (CMBs) are common in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF).
  • The impact of CMBs on outcomes in patients treated with oral anticoagulants (OACs) requires further investigation.
  • Understanding CMBs' role is crucial for managing stroke and cardiovascular risk.

Purpose of the Study:

  • To investigate the association between CMB presence, burden, and location with major adverse cerebrovascular and cardiovascular events (MACCE).
  • To evaluate if the type of OAC influences the clinical effect of CMBs on MACCE risk.

Main Methods:

  • A cohort study of 1742 patients with AIS and AF treated with OACs.
  • Assessed the occurrence of MACCE (stroke, myocardial infarction, vascular death) over a 2-year period.
  • Analyzed CMB status, burden, and location in relation to MACCE risk.

Main Results:

  • CMB presence significantly increased MACCE risk (HR, 1.89).
  • Multiple CMBs (≥2) and high burden CMBs (≥5) were associated with significantly higher MACCE rates.
  • CMB location (lobar vs. deep) did not impact MACCE risk.
  • CMB association with MACCE was significant with warfarin but not with direct OACs.

Conclusions:

  • Increased CMB burden correlates with higher MACCE risk in AIS/AF patients on OACs.
  • CMB location does not influence MACCE risk.
  • The association between CMBs and MACCE appears more pronounced with warfarin compared to direct OACs.
Keywords:
anticoagulantsatrial fibrillationembolismmicrobleedsecondary prevention

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