Stroke Risk and Antithrombotic Treatment During Follow-up of Patients With Ischemic Stroke and Cortical Superficial

Joan Martí-Fàbregas1, Pol Camps-Renom2, Jonathan G Best2

  • 1From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey. jmarti@santpau.cat.

Neurology
|December 19, 2022
PubMed

Insights

Cortical superficial siderosis (cSS) increases stroke risk in patients with ischemic stroke or TIA. While single antithrombotic treatments are safe, combined therapy with cSS may raise intracranial hemorrhage risk.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Neuroimaging

Background:

  • Limited data exist on secondary stroke prevention in patients with ischemic stroke (IS) or transient ischemic attack (TIA) and cortical superficial siderosis (cSS).
  • Investigating the association between cSS and future cerebrovascular events is crucial for risk stratification and treatment decisions.

Purpose of the Study:

  • To investigate the association between cSS and the risk of future cerebrovascular events in patients with recent IS or TIA.
  • To evaluate the benefits and safety of antithrombotic drugs for secondary prevention in this patient group.

Main Methods:

  • Retrospective analysis of the Microbleeds International Collaborative Network (MICON) database.
  • Inclusion of patients with IS or TIA, MRI-assessed cSS, and data on antithrombotic treatments and recurrent cerebrovascular events.
  • Calculation of incidence rates and multivariable Cox regression analyses to assess stroke risk.

Main Results:

  • cSS was detected in 2.2% of 12,669 patients.
  • cSS was associated with an increased risk of any stroke (HR 1.62; p=0.006) compared to non-cSS.
  • Patients with cSS on dual antithrombotic therapy showed a significantly higher risk of intracranial hemorrhage (HR 13.26; p=0.001) and any stroke (HR 5.03; p<0.001).

Conclusions:

  • Patients with IS/TIA and cSS face an elevated stroke risk.
  • Antiplatelet or anticoagulant monotherapy appears safe in patients with cSS.
  • Combined antithrombotic therapy in patients with cSS may increase the risk of intracranial hemorrhage and should be used with caution, pending further randomized trials.
Abstract

Related Concept Videos

Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
16
Venous Thrombosis IV: Nursing Management01:30

Venous Thrombosis IV: Nursing Management

Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
19
Atherosclerosis III: Management01:26

Atherosclerosis III: Management

Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
19
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.3K
Atherosclerosis IV: Nursing Management01:23

Atherosclerosis IV: Nursing Management

Nursing management for a patient with arteriosclerosis involves a comprehensive approach focusing on lifestyle modification, disease monitoring, education, and symptomatic care. Here is an overview of effective nursing strategies:Assessment and Monitoring: Initial and ongoing assessments are crucial. Nurses must document the patient's medical history, including any hypertension, diabetes, hyperlipidemia, and other cardiovascular diseases. Assessments also cover family history and lifestyle...
35
Peripheral Artery Disease V: Postoperative Nursing Management01:23

Peripheral Artery Disease V: Postoperative Nursing Management

During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
17