Impact of type of oral anticoagulants in patients with cerebral microbleeds after atrial fibrillation-related ischemic stroke or TIA: Results of the NOACISP-LONGTERM registry
BackgroundCerebral microbleeds (CMBs) may have a differential impact on clinical outcome in stroke patients with atrial fibrillation (AF) treated with different types of oral anticoagulation (OAC).MethodsObservational single-center study on AF-stroke-patients treated with OAC. Magnetic-resonance-ima...
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.964723/full |
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| author | Benjamin Wagner Lisa Hert Lisa Hert Alexandros A. Polymeris Sabine Schaedelin Johanna M. Lieb David J. Seiffge David J. Seiffge Christopher Traenka Christopher Traenka Sebastian Thilemann Joachim Fladt Valerian L. Altersberger Annaelle Zietz Tolga D. Dittrich Urs Fisch Henrik Gensicke Henrik Gensicke Gian Marco De Marchis Leo H. Bonati Philippe A. Lyrer Stefan T. Engelter Stefan T. Engelter Nils Peters Nils Peters Nils Peters |
| author_facet | Benjamin Wagner Lisa Hert Lisa Hert Alexandros A. Polymeris Sabine Schaedelin Johanna M. Lieb David J. Seiffge David J. Seiffge Christopher Traenka Christopher Traenka Sebastian Thilemann Joachim Fladt Valerian L. Altersberger Annaelle Zietz Tolga D. Dittrich Urs Fisch Henrik Gensicke Henrik Gensicke Gian Marco De Marchis Leo H. Bonati Philippe A. Lyrer Stefan T. Engelter Stefan T. Engelter Nils Peters Nils Peters Nils Peters |
| author_sort | Benjamin Wagner |
| collection | DOAJ |
| description | BackgroundCerebral microbleeds (CMBs) may have a differential impact on clinical outcome in stroke patients with atrial fibrillation (AF) treated with different types of oral anticoagulation (OAC).MethodsObservational single-center study on AF-stroke-patients treated with OAC. Magnetic-resonance-imaging was performed to assess CMBs. Outcome measures consisted of recurrent ischemic stroke (IS), intracranial hemorrhage (ICH), death, and their combined analysis. Functional disability was assessed by mRS. Using adjusted logistic regression and Cox proportional-hazards models, we assessed the association of the presence of CMBs and OAC type (vitamin K antagonists [VKAs] vs. direct oral anticoagulants [DOACs]) with clinical outcome.ResultsOf 310 AF-stroke patients treated with OAC [DOACs: n = 234 (75%); VKAs: n = 76 (25%)], CMBs were present in 86 (28%) patients; of these, 66 (77%) received DOACs. In both groups, CMBs were associated with an increased risk for the composite outcome: VKAs: HR 3.654 [1.614; 8.277]; p = 0.002; DOACs: HR 2.230 [1.233; 4.034]; p = 0.008. Patients with CMBs had ~50% higher absolute rates of the composite outcome compared to the overall cohort, with a comparable ratio between treatment groups [VKAs 13/20(65%) vs. DOACs 19/66(29%); p < 0.01]. The VKA-group had a 2-fold higher IS [VKAs:4 (20%) vs. DOACs:6 (9%); p = 0.35] and a 10-fold higher ICH rate [VKAs: 3 (15%) vs. DOACs: 1 (1.5%); p = 0.038]. No significant interaction was observed between type of OAC and presence of CMBs. DOAC-patients showed a significantly better functional outcome (OR 0.40 [0.17; 0.94]; p = 0.04).ConclusionsIn AF-stroke patients treated with OAC, the presence of CMBs was associated with an unfavorable composite outcome for both VKAs and DOACs, with a higher risk for recurrent IS than for ICH. Strokes were numerically higher under VKAs and increased in the presence of CMBs.Clinical trial registrationhttp://www.clinicaltrials.gov, Unique identifier: NCT03826927. |
| first_indexed | 2024-04-14T08:17:16Z |
| format | Article |
| id | doaj.art-5116b2ca04544fe89ea82f88d4e3ec99 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-14T08:17:16Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-5116b2ca04544fe89ea82f88d4e3ec992022-12-22T02:04:21ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-09-011310.3389/fneur.2022.964723964723Impact of type of oral anticoagulants in patients with cerebral microbleeds after atrial fibrillation-related ischemic stroke or TIA: Results of the NOACISP-LONGTERM registryBenjamin Wagner0Lisa Hert1Lisa Hert2Alexandros A. Polymeris3Sabine Schaedelin4Johanna M. Lieb5David J. Seiffge6David J. Seiffge7Christopher Traenka8Christopher Traenka9Sebastian Thilemann10Joachim Fladt11Valerian L. Altersberger12Annaelle Zietz13Tolga D. Dittrich14Urs Fisch15Henrik Gensicke16Henrik Gensicke17Gian Marco De Marchis18Leo H. Bonati19Philippe A. Lyrer20Stefan T. Engelter21Stefan T. Engelter22Nils Peters23Nils Peters24Nils Peters25Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandDepartment of Intensive Care Medicine, University Hospital Basel and University of Basel, Basel, SwitzerlandDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandClinical Trial Unit, University Hospital Basel and University of Basel, Basel, SwitzerlandDepartment of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Basel, SwitzerlandDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandNeurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter and Department of Clinical Research, University of Basel, Basel, SwitzerlandDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandNeurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter and Department of Clinical Research, University of Basel, Basel, SwitzerlandDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandNeurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter and Department of Clinical Research, University of Basel, Basel, SwitzerlandDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, SwitzerlandNeurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter and Department of Clinical Research, University of Basel, Basel, SwitzerlandStroke Center, Klinik Hirslanden Zurich, Zurich, SwitzerlandBackgroundCerebral microbleeds (CMBs) may have a differential impact on clinical outcome in stroke patients with atrial fibrillation (AF) treated with different types of oral anticoagulation (OAC).MethodsObservational single-center study on AF-stroke-patients treated with OAC. Magnetic-resonance-imaging was performed to assess CMBs. Outcome measures consisted of recurrent ischemic stroke (IS), intracranial hemorrhage (ICH), death, and their combined analysis. Functional disability was assessed by mRS. Using adjusted logistic regression and Cox proportional-hazards models, we assessed the association of the presence of CMBs and OAC type (vitamin K antagonists [VKAs] vs. direct oral anticoagulants [DOACs]) with clinical outcome.ResultsOf 310 AF-stroke patients treated with OAC [DOACs: n = 234 (75%); VKAs: n = 76 (25%)], CMBs were present in 86 (28%) patients; of these, 66 (77%) received DOACs. In both groups, CMBs were associated with an increased risk for the composite outcome: VKAs: HR 3.654 [1.614; 8.277]; p = 0.002; DOACs: HR 2.230 [1.233; 4.034]; p = 0.008. Patients with CMBs had ~50% higher absolute rates of the composite outcome compared to the overall cohort, with a comparable ratio between treatment groups [VKAs 13/20(65%) vs. DOACs 19/66(29%); p < 0.01]. The VKA-group had a 2-fold higher IS [VKAs:4 (20%) vs. DOACs:6 (9%); p = 0.35] and a 10-fold higher ICH rate [VKAs: 3 (15%) vs. DOACs: 1 (1.5%); p = 0.038]. No significant interaction was observed between type of OAC and presence of CMBs. DOAC-patients showed a significantly better functional outcome (OR 0.40 [0.17; 0.94]; p = 0.04).ConclusionsIn AF-stroke patients treated with OAC, the presence of CMBs was associated with an unfavorable composite outcome for both VKAs and DOACs, with a higher risk for recurrent IS than for ICH. Strokes were numerically higher under VKAs and increased in the presence of CMBs.Clinical trial registrationhttp://www.clinicaltrials.gov, Unique identifier: NCT03826927.https://www.frontiersin.org/articles/10.3389/fneur.2022.964723/fullstrokeatrial fibrillationanticoagulationdirect-acting oral anticoagulantcerebral microbleedssmall vessel disease |
| spellingShingle | Benjamin Wagner Lisa Hert Lisa Hert Alexandros A. Polymeris Sabine Schaedelin Johanna M. Lieb David J. Seiffge David J. Seiffge Christopher Traenka Christopher Traenka Sebastian Thilemann Joachim Fladt Valerian L. Altersberger Annaelle Zietz Tolga D. Dittrich Urs Fisch Henrik Gensicke Henrik Gensicke Gian Marco De Marchis Leo H. Bonati Philippe A. Lyrer Stefan T. Engelter Stefan T. Engelter Nils Peters Nils Peters Nils Peters Impact of type of oral anticoagulants in patients with cerebral microbleeds after atrial fibrillation-related ischemic stroke or TIA: Results of the NOACISP-LONGTERM registry Frontiers in Neurology stroke atrial fibrillation anticoagulation direct-acting oral anticoagulant cerebral microbleeds small vessel disease |
| title | Impact of type of oral anticoagulants in patients with cerebral microbleeds after atrial fibrillation-related ischemic stroke or TIA: Results of the NOACISP-LONGTERM registry |
| title_full | Impact of type of oral anticoagulants in patients with cerebral microbleeds after atrial fibrillation-related ischemic stroke or TIA: Results of the NOACISP-LONGTERM registry |
| title_fullStr | Impact of type of oral anticoagulants in patients with cerebral microbleeds after atrial fibrillation-related ischemic stroke or TIA: Results of the NOACISP-LONGTERM registry |
| title_full_unstemmed | Impact of type of oral anticoagulants in patients with cerebral microbleeds after atrial fibrillation-related ischemic stroke or TIA: Results of the NOACISP-LONGTERM registry |
| title_short | Impact of type of oral anticoagulants in patients with cerebral microbleeds after atrial fibrillation-related ischemic stroke or TIA: Results of the NOACISP-LONGTERM registry |
| title_sort | impact of type of oral anticoagulants in patients with cerebral microbleeds after atrial fibrillation related ischemic stroke or tia results of the noacisp longterm registry |
| topic | stroke atrial fibrillation anticoagulation direct-acting oral anticoagulant cerebral microbleeds small vessel disease |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.964723/full |
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