MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation.
Aged
Aged, 80 and over
Anticoagulants
/ therapeutic use
Cerebral Small Vessel Diseases
/ diagnostic imaging
Female
Humans
Intracranial Embolism
/ prevention & control
Intracranial Hemorrhages
/ epidemiology
Magnetic Resonance Imaging
Male
Multivariate Analysis
Proportional Hazards Models
Prospective Studies
Risk Assessment
Stroke
/ prevention & control
Journal
Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060
Informations de publication
Date de publication:
21 05 2019
21 05 2019
Historique:
received:
25
08
2018
accepted:
24
01
2019
pubmed:
21
4
2019
medline:
21
12
2019
entrez:
21
4
2019
Statut:
ppublish
Résumé
We tested the hypothesis that the risk of intracranial hemorrhage (ICH) in patients with cardioembolic ischemic stroke who are treated with oral anticoagulants (OAs) can be predicted by evaluating surrogate markers of hemorrhagic-prone cerebral angiopathies using a baseline MRI. Patients were participants in a multicenter and prospective observational study. They were older than 64 years, had a recent cardioembolic ischemic stroke, and were new users of OAs. They underwent a baseline MRI analysis to evaluate microbleeds, white matter hyperintensities, and cortical superficial siderosis. We collected demographic variables, clinical characteristics, risk scores, and therapeutic data. The primary endpoint was ICH that occurred during follow-up. We performed bivariate and multivariate Cox regression analyses. We recruited 937 patients (aged 77.6 ± 6.5 years; 47.9% were men). Microbleeds were detected in 207 patients (22.5%), moderate/severe white matter hyperintensities in 419 (45.1%), and superficial siderosis in 28 patients (3%). After a mean follow-up of 23.1 ± 6.8 months, 18 patients (1.9%) experienced an ICH. In multivariable analysis, microbleeds (hazard ratio 2.7, 95% confidence interval [CI] 1.1-7, Patients taking OAs who have advanced cerebral small vessel disease, evidenced by microbleeds and moderate to severe white matter hyperintensities, had an increased risk of ICH. Our results should help to determine the risk of prescribing OA for a patient with cardioembolic stroke. NCT02238470.
Identifiants
pubmed: 31004066
pii: WNL.0000000000007532
doi: 10.1212/WNL.0000000000007532
pmc: PMC6541433
doi:
Substances chimiques
Anticoagulants
0
Banques de données
ClinicalTrials.gov
['NCT02238470']
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e2432-e2443Commentaires et corrections
Type : CommentIn
Type : ErratumIn
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2019 American Academy of Neurology.
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