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A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia

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Prediction Model to Optimize Long-Term Antithrombotic Therapy Using Covert Vascular Brain Injury and Clinical

Kaori Miwa¹, Kenta Tanaka², Masatoshi Koga¹

¹Department of Cerebrovascular Medicine (K.M., M.K., Kanta Tanaka, M. Shiozawa, Sohei Yoshimura, K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan.

|June 19, 2025

Summary

New BAT2 scores predict major bleeding, intracranial hemorrhage (ICH), and ischemic stroke (IS) in patients on antithrombotic therapy. These scores incorporate covert vascular brain injury for personalized risk assessment, improving treatment decisions.

Keywords:

anticoagulants atrial fibrillation cerebrovascular disorders intracranial hemorrhages ischemic stroke platelet aggregation inhibitors

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Last Updated: Sep 19, 2025

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Intrastriatal Injection of Autologous Blood or Clostridial Collagenase as Murine Models of Intracerebral Hemorrhage

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Published on: July 3, 2014

Area of Science:

Neurology
Cardiology
Vascular Medicine

Background:

Accurate risk assessment for major bleeding, intracranial hemorrhage (ICH), and ischemic stroke (IS) is vital for patients on antithrombotic therapy.
Existing risk prediction tools are insufficient for evaluating the net clinical benefit of antithrombotic treatments.
Covert vascular brain injury assessment is needed to personalize risk stratification.

Purpose of the Study:

To develop novel risk scores, the BAT2 scores, for predicting major bleeding, ICH, and IS.
To incorporate multimodal brain imaging findings, including cerebral small vessel disease, into risk prediction.
To personalize risk assessment for patients receiving antithrombotic therapy.

Main Methods:

Prospective, multicenter observational study (BAT2) of patients on oral antiplatelets or anticoagulants.
Multimodal brain MRI at baseline to assess cerebral small vessel disease, infarcts, and intracranial artery disease.
Development of risk scores using Cox proportional hazards models and validated with Harrell C-index and calibration slope.

Main Results:

The study analyzed 5250 patients with a median follow-up of 2.0 years.
Identified predictors for major bleeding, ICH, and IS, including age, renal impairment, and various brain imaging markers.
Achieved optimism-adjusted C-indices ranging from 0.64 to 0.75 for the prediction models.

Conclusions:

The developed BAT2 scores can aid in optimizing the risk-benefit balance of antithrombotic therapy.
Personalized risk assessment incorporating vascular brain injury may improve patient outcomes.
These scores offer a valuable tool for clinicians managing patients on antithrombotic agents.