Brain microbleeds, anticoagulation, and hemorrhage risk: Meta-analysis in stroke patients with AF

Andreas Charidimou, Christopher Karayiannis, Tae Jin Song, Dilek Necioglu Orken, Vincent Thijs, Robin Lemmens, Jinkwon Kim, Su Mei Goh, Thanh G. Phan, Cathy Soufan, Ronil V. Chandra, Lee Anne Slater, Shamir Haji, Vincent Mok, Solveig Horstmann, Kam Tat Leung, Yuichiro Kawamura, Nobuyuki Sato, Naoyuki Hasebe, Tsukasa SaitoLawrence K.S. Wong, Yannie Soo, Roland Veltkamp, Kelly D. Flemming, Toshio Imaizumi, Velandai Srikanth, Jihoe Heo

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objectives: To assess the association between cerebral microbleeds (CMBs) and future spontaneous intracerebral hemorrhage (ICH) risk in ischemic stroke patients with nonvalvular atrial fibrillation (AF) taking oral anticoagulants. Methods: This was a meta-analysis of cohort studies with.50 patients with recent ischemic stroke and documented AF, brain MRI at baseline, long-term oral anticoagulation treatment, and ≥6 months of follow-up. Authors provided summary-level data on stroke outcomes stratified by CMB status. We estimated pooled annualized ICH and ischemic stroke rates from Poisson regression. We calculated odds ratios (ORs) of ICH by CMB presence/absence, ≥5 CMBs, and CMB topography (strictly lobar, mixed, and strictly deep) using random-effects models. Results: We established an international collaboration and pooled data from 8 centers including 1,552 patients. The crude CMB prevalence was 30% and 7% for ≥5 CMBs. Baseline CMB presence (vs no CMB) was associated with ICH during follow-up (OR 2.68, 95% confidence interval [CI] 1.19-6.01, p = 0.017). Presence of ≥5 CMB was related to higher future ICH risk (OR 5.50, 95% CI 2.07-14.66, p = 0.001). The pooled annual ICH incidence increased from 0.30% (95% CI 0.04-0.55) among CMB-negative patients to 0.81% (95% CI 0.17-1.45) in CMB-positive patients (p = 0.01) and 2.48% (95% CI 1.2-6.2) in patients with ≥5 CMBs (p = 0.001). There was no association between CMBs and recurrent ischemic stroke. Conclusions: The presence of CMB on MRI and the dichotomized cutoff of ≥5 CMBs might identify subgroups of ischemic stroke patients with AF with high ICH risk and after further validation could help in risk stratification, in anticoagulation decisions, and in guiding randomized trials and ongoing large observational studies.

Original languageEnglish
Pages (from-to)2317-2326
Number of pages10
JournalNeurology
Volume89
Issue number23
DOIs
Publication statusPublished - 2017 Dec 1

Fingerprint

Cerebral Hemorrhage
Atrial Fibrillation
Meta-Analysis
Stroke
Hemorrhage
Brain
Confidence Intervals
Odds Ratio
Anticoagulants
Observational Studies
Cohort Studies
Incidence

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Charidimou, A., Karayiannis, C., Song, T. J., Orken, D. N., Thijs, V., Lemmens, R., ... Heo, J. (2017). Brain microbleeds, anticoagulation, and hemorrhage risk: Meta-analysis in stroke patients with AF. Neurology, 89(23), 2317-2326. https://doi.org/10.1212/WNL.0000000000004704
Charidimou, Andreas ; Karayiannis, Christopher ; Song, Tae Jin ; Orken, Dilek Necioglu ; Thijs, Vincent ; Lemmens, Robin ; Kim, Jinkwon ; Goh, Su Mei ; Phan, Thanh G. ; Soufan, Cathy ; Chandra, Ronil V. ; Slater, Lee Anne ; Haji, Shamir ; Mok, Vincent ; Horstmann, Solveig ; Leung, Kam Tat ; Kawamura, Yuichiro ; Sato, Nobuyuki ; Hasebe, Naoyuki ; Saito, Tsukasa ; Wong, Lawrence K.S. ; Soo, Yannie ; Veltkamp, Roland ; Flemming, Kelly D. ; Imaizumi, Toshio ; Srikanth, Velandai ; Heo, Jihoe. / Brain microbleeds, anticoagulation, and hemorrhage risk : Meta-analysis in stroke patients with AF. In: Neurology. 2017 ; Vol. 89, No. 23. pp. 2317-2326.
@article{cbf4bad8494547e0b58ffec8740094b1,
title = "Brain microbleeds, anticoagulation, and hemorrhage risk: Meta-analysis in stroke patients with AF",
abstract = "Objectives: To assess the association between cerebral microbleeds (CMBs) and future spontaneous intracerebral hemorrhage (ICH) risk in ischemic stroke patients with nonvalvular atrial fibrillation (AF) taking oral anticoagulants. Methods: This was a meta-analysis of cohort studies with.50 patients with recent ischemic stroke and documented AF, brain MRI at baseline, long-term oral anticoagulation treatment, and ≥6 months of follow-up. Authors provided summary-level data on stroke outcomes stratified by CMB status. We estimated pooled annualized ICH and ischemic stroke rates from Poisson regression. We calculated odds ratios (ORs) of ICH by CMB presence/absence, ≥5 CMBs, and CMB topography (strictly lobar, mixed, and strictly deep) using random-effects models. Results: We established an international collaboration and pooled data from 8 centers including 1,552 patients. The crude CMB prevalence was 30{\%} and 7{\%} for ≥5 CMBs. Baseline CMB presence (vs no CMB) was associated with ICH during follow-up (OR 2.68, 95{\%} confidence interval [CI] 1.19-6.01, p = 0.017). Presence of ≥5 CMB was related to higher future ICH risk (OR 5.50, 95{\%} CI 2.07-14.66, p = 0.001). The pooled annual ICH incidence increased from 0.30{\%} (95{\%} CI 0.04-0.55) among CMB-negative patients to 0.81{\%} (95{\%} CI 0.17-1.45) in CMB-positive patients (p = 0.01) and 2.48{\%} (95{\%} CI 1.2-6.2) in patients with ≥5 CMBs (p = 0.001). There was no association between CMBs and recurrent ischemic stroke. Conclusions: The presence of CMB on MRI and the dichotomized cutoff of ≥5 CMBs might identify subgroups of ischemic stroke patients with AF with high ICH risk and after further validation could help in risk stratification, in anticoagulation decisions, and in guiding randomized trials and ongoing large observational studies.",
author = "Andreas Charidimou and Christopher Karayiannis and Song, {Tae Jin} and Orken, {Dilek Necioglu} and Vincent Thijs and Robin Lemmens and Jinkwon Kim and Goh, {Su Mei} and Phan, {Thanh G.} and Cathy Soufan and Chandra, {Ronil V.} and Slater, {Lee Anne} and Shamir Haji and Vincent Mok and Solveig Horstmann and Leung, {Kam Tat} and Yuichiro Kawamura and Nobuyuki Sato and Naoyuki Hasebe and Tsukasa Saito and Wong, {Lawrence K.S.} and Yannie Soo and Roland Veltkamp and Flemming, {Kelly D.} and Toshio Imaizumi and Velandai Srikanth and Jihoe Heo",
year = "2017",
month = "12",
day = "1",
doi = "10.1212/WNL.0000000000004704",
language = "English",
volume = "89",
pages = "2317--2326",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "23",

}

Charidimou, A, Karayiannis, C, Song, TJ, Orken, DN, Thijs, V, Lemmens, R, Kim, J, Goh, SM, Phan, TG, Soufan, C, Chandra, RV, Slater, LA, Haji, S, Mok, V, Horstmann, S, Leung, KT, Kawamura, Y, Sato, N, Hasebe, N, Saito, T, Wong, LKS, Soo, Y, Veltkamp, R, Flemming, KD, Imaizumi, T, Srikanth, V & Heo, J 2017, 'Brain microbleeds, anticoagulation, and hemorrhage risk: Meta-analysis in stroke patients with AF', Neurology, vol. 89, no. 23, pp. 2317-2326. https://doi.org/10.1212/WNL.0000000000004704

Brain microbleeds, anticoagulation, and hemorrhage risk : Meta-analysis in stroke patients with AF. / Charidimou, Andreas; Karayiannis, Christopher; Song, Tae Jin; Orken, Dilek Necioglu; Thijs, Vincent; Lemmens, Robin; Kim, Jinkwon; Goh, Su Mei; Phan, Thanh G.; Soufan, Cathy; Chandra, Ronil V.; Slater, Lee Anne; Haji, Shamir; Mok, Vincent; Horstmann, Solveig; Leung, Kam Tat; Kawamura, Yuichiro; Sato, Nobuyuki; Hasebe, Naoyuki; Saito, Tsukasa; Wong, Lawrence K.S.; Soo, Yannie; Veltkamp, Roland; Flemming, Kelly D.; Imaizumi, Toshio; Srikanth, Velandai; Heo, Jihoe.

In: Neurology, Vol. 89, No. 23, 01.12.2017, p. 2317-2326.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Brain microbleeds, anticoagulation, and hemorrhage risk

T2 - Meta-analysis in stroke patients with AF

AU - Charidimou, Andreas

AU - Karayiannis, Christopher

AU - Song, Tae Jin

AU - Orken, Dilek Necioglu

AU - Thijs, Vincent

AU - Lemmens, Robin

AU - Kim, Jinkwon

AU - Goh, Su Mei

AU - Phan, Thanh G.

AU - Soufan, Cathy

AU - Chandra, Ronil V.

AU - Slater, Lee Anne

AU - Haji, Shamir

AU - Mok, Vincent

AU - Horstmann, Solveig

AU - Leung, Kam Tat

AU - Kawamura, Yuichiro

AU - Sato, Nobuyuki

AU - Hasebe, Naoyuki

AU - Saito, Tsukasa

AU - Wong, Lawrence K.S.

AU - Soo, Yannie

AU - Veltkamp, Roland

AU - Flemming, Kelly D.

AU - Imaizumi, Toshio

AU - Srikanth, Velandai

AU - Heo, Jihoe

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Objectives: To assess the association between cerebral microbleeds (CMBs) and future spontaneous intracerebral hemorrhage (ICH) risk in ischemic stroke patients with nonvalvular atrial fibrillation (AF) taking oral anticoagulants. Methods: This was a meta-analysis of cohort studies with.50 patients with recent ischemic stroke and documented AF, brain MRI at baseline, long-term oral anticoagulation treatment, and ≥6 months of follow-up. Authors provided summary-level data on stroke outcomes stratified by CMB status. We estimated pooled annualized ICH and ischemic stroke rates from Poisson regression. We calculated odds ratios (ORs) of ICH by CMB presence/absence, ≥5 CMBs, and CMB topography (strictly lobar, mixed, and strictly deep) using random-effects models. Results: We established an international collaboration and pooled data from 8 centers including 1,552 patients. The crude CMB prevalence was 30% and 7% for ≥5 CMBs. Baseline CMB presence (vs no CMB) was associated with ICH during follow-up (OR 2.68, 95% confidence interval [CI] 1.19-6.01, p = 0.017). Presence of ≥5 CMB was related to higher future ICH risk (OR 5.50, 95% CI 2.07-14.66, p = 0.001). The pooled annual ICH incidence increased from 0.30% (95% CI 0.04-0.55) among CMB-negative patients to 0.81% (95% CI 0.17-1.45) in CMB-positive patients (p = 0.01) and 2.48% (95% CI 1.2-6.2) in patients with ≥5 CMBs (p = 0.001). There was no association between CMBs and recurrent ischemic stroke. Conclusions: The presence of CMB on MRI and the dichotomized cutoff of ≥5 CMBs might identify subgroups of ischemic stroke patients with AF with high ICH risk and after further validation could help in risk stratification, in anticoagulation decisions, and in guiding randomized trials and ongoing large observational studies.

AB - Objectives: To assess the association between cerebral microbleeds (CMBs) and future spontaneous intracerebral hemorrhage (ICH) risk in ischemic stroke patients with nonvalvular atrial fibrillation (AF) taking oral anticoagulants. Methods: This was a meta-analysis of cohort studies with.50 patients with recent ischemic stroke and documented AF, brain MRI at baseline, long-term oral anticoagulation treatment, and ≥6 months of follow-up. Authors provided summary-level data on stroke outcomes stratified by CMB status. We estimated pooled annualized ICH and ischemic stroke rates from Poisson regression. We calculated odds ratios (ORs) of ICH by CMB presence/absence, ≥5 CMBs, and CMB topography (strictly lobar, mixed, and strictly deep) using random-effects models. Results: We established an international collaboration and pooled data from 8 centers including 1,552 patients. The crude CMB prevalence was 30% and 7% for ≥5 CMBs. Baseline CMB presence (vs no CMB) was associated with ICH during follow-up (OR 2.68, 95% confidence interval [CI] 1.19-6.01, p = 0.017). Presence of ≥5 CMB was related to higher future ICH risk (OR 5.50, 95% CI 2.07-14.66, p = 0.001). The pooled annual ICH incidence increased from 0.30% (95% CI 0.04-0.55) among CMB-negative patients to 0.81% (95% CI 0.17-1.45) in CMB-positive patients (p = 0.01) and 2.48% (95% CI 1.2-6.2) in patients with ≥5 CMBs (p = 0.001). There was no association between CMBs and recurrent ischemic stroke. Conclusions: The presence of CMB on MRI and the dichotomized cutoff of ≥5 CMBs might identify subgroups of ischemic stroke patients with AF with high ICH risk and after further validation could help in risk stratification, in anticoagulation decisions, and in guiding randomized trials and ongoing large observational studies.

UR - http://www.scopus.com/inward/record.url?scp=85038233793&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85038233793&partnerID=8YFLogxK

U2 - 10.1212/WNL.0000000000004704

DO - 10.1212/WNL.0000000000004704

M3 - Article

C2 - 29117953

AN - SCOPUS:85038233793

VL - 89

SP - 2317

EP - 2326

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 23

ER -

Charidimou A, Karayiannis C, Song TJ, Orken DN, Thijs V, Lemmens R et al. Brain microbleeds, anticoagulation, and hemorrhage risk: Meta-analysis in stroke patients with AF. Neurology. 2017 Dec 1;89(23):2317-2326. https://doi.org/10.1212/WNL.0000000000004704