Prevalence of atrial fibrillation and association of previous antithrombotic treatment in patients with cerebral microbleeds

TY - JOUR

T1 - Prevalence of atrial fibrillation and association of previous antithrombotic treatment in patients with cerebral microbleeds

AU - Horstmann, S

AU - Möhlenbruch, M

AU - Wegele, C

AU - Rizos, T

AU - Laible, M

AU - Rauch, G

AU - Veltkamp, R

N1 - © 2014 EAN.

PY - 2015/10

Y1 - 2015/10

N2 - BACKGROUND AND PURPOSE: Cerebral microbleeds (CMBs) are associated with an increased risk of intracerebral hemorrhage. The impact of oral anticoagulation (OAC) on CMBs is not well characterized. Our aim was to assess the prevalence of CMBs in stroke and transient ischaemic attack (TIA) patients with atrial fibrillation (AF) and to analyze the implications of previous treatment with OAC.METHODS: In this retrospective analysis on data from a prospectively recruiting stroke registry, patients with ischaemic stroke or TIA with brain magnetic resonance imaging including susceptibility weighted imaging were consecutively enrolled during a 3-year period. For each patient cardiovascular risk factors, AF history and recent diagnosis of AF, present use of OAC and antiplatelets, the National Institute of Health Stroke Scale and the premorbid modified Rankin Scale score were recorded. Two independent raters identified CMBs according to consensus criteria. CMB location was classified as lobar, deep or in the posterior fossa.RESULTS: In all, 785 patients (mean age 63.9 ± 14.2 years) were included. At least one CMB was detected in 186 (23.7%) patients. CMBs were significantly more frequent in patients with AF (30.5% vs. 22.4%). Patients with previous OAC treatment were more likely to have CMBs (36.7% vs. 22.8%, P = 0.03) and abundant CMBs (n > 10) were more frequent in anticoagulated patients even after adjustment for age. However, age was the only independent factor predicting CMBs (P = 0.001).CONCLUSIONS: Cerebral microbleeds are common in elderly AF patients with acute ischaemic stroke. Previous OAC is associated with a higher number of CMBs predominantly in the lobar location. Establishing a causal relationship requires prospective longitudinal investigation.

AB - BACKGROUND AND PURPOSE: Cerebral microbleeds (CMBs) are associated with an increased risk of intracerebral hemorrhage. The impact of oral anticoagulation (OAC) on CMBs is not well characterized. Our aim was to assess the prevalence of CMBs in stroke and transient ischaemic attack (TIA) patients with atrial fibrillation (AF) and to analyze the implications of previous treatment with OAC.METHODS: In this retrospective analysis on data from a prospectively recruiting stroke registry, patients with ischaemic stroke or TIA with brain magnetic resonance imaging including susceptibility weighted imaging were consecutively enrolled during a 3-year period. For each patient cardiovascular risk factors, AF history and recent diagnosis of AF, present use of OAC and antiplatelets, the National Institute of Health Stroke Scale and the premorbid modified Rankin Scale score were recorded. Two independent raters identified CMBs according to consensus criteria. CMB location was classified as lobar, deep or in the posterior fossa.RESULTS: In all, 785 patients (mean age 63.9 ± 14.2 years) were included. At least one CMB was detected in 186 (23.7%) patients. CMBs were significantly more frequent in patients with AF (30.5% vs. 22.4%). Patients with previous OAC treatment were more likely to have CMBs (36.7% vs. 22.8%, P = 0.03) and abundant CMBs (n > 10) were more frequent in anticoagulated patients even after adjustment for age. However, age was the only independent factor predicting CMBs (P = 0.001).CONCLUSIONS: Cerebral microbleeds are common in elderly AF patients with acute ischaemic stroke. Previous OAC is associated with a higher number of CMBs predominantly in the lobar location. Establishing a causal relationship requires prospective longitudinal investigation.

KW - Aged

KW - Aged, 80 and over

KW - Anticoagulants

KW - Atrial Fibrillation

KW - Cerebral Hemorrhage

KW - Comorbidity

KW - Female

KW - Humans

KW - Ischemic Attack, Transient

KW - Male

KW - Middle Aged

KW - Prevalence

KW - Prospective Studies

KW - Registries

KW - Retrospective Studies

KW - Stroke

KW - Journal Article

KW - Observational Study

KW - Research Support, Non-U.S. Gov't

U2 - 10.1111/ene.12608

DO - 10.1111/ene.12608

M3 - SCORING: Journal article

C2 - 25557113

VL - 22

SP - 1355

EP - 1362

JO - EUR J NEUROL

JF - EUR J NEUROL

SN - 1351-5101

IS - 10

ER -