Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation

Yannie Soo¹, Annaelle Zietz², Brian Yiu¹, Vincent C T Mok^{1

3}, Alexandros A Polymeris², David Seiffge⁴, Gareth Ambler⁵, Duncan Wilson⁶, Thomas Wai Hong Leung¹, Suk Fung Tsang¹, Winnie Chu⁷, Jill Abrigo⁷, Cyrus Cheng¹, Keon-Joo Lee⁸, Jae-Sung Lim⁹, Masayuki Shiozawa¹⁰, Masatoshi Koga¹⁰, Hugues Chabriat¹¹, Michael Hennerici¹², Yuen Kwun Wong¹³, Henry Mak¹⁴, Roger Collet¹⁵, Shigeru Inamura¹⁶, Kazuhisa Yoshifuji¹⁶, Ethem Murat Arsava¹⁷, Solveig Horstmann¹⁸, Jan Purrucker¹⁸, Bonnie Y K Lam^{1

3}, Adrian Wong³, Young Dae Kim¹⁹, Tae-Jin Song²⁰, Robin Lemmens^{21

22

23}, Sebastian Eppinger^{24

25}, Thomas Gattringer^{24

25}, Ender Uysal²⁶, Derya Selçuk Demirelli²⁷, Natan M Bornstein^{28

29}, Einor Ben Assayag^{28

29}, Hen Hallevi^{28

29}, Jeremy Molad^{28

29}, Masashi Nishihara³⁰, Jun Tanaka³¹, Shelagh B Coutts³², L Jaap Kappelle³³, Rustam Al-Shahi Salman³⁴, Rolf Jager³⁵, Gregory Y H Lip^{36

37}, Martina B Goeldlin⁴, Leonidas D Panos⁴, Jean-Louis Mas³⁸, Laurence Legrand³⁹, Chris Karayiannis⁴⁰, Thanh Phan⁴¹, Maximilian Bellut⁴², Francesca Chappell^{43

44}, Stephen Makin⁴⁵, Derek Hayden⁴⁶, David Williams⁴⁷, Dianne H K van Dam-Nolen⁴⁸, Paul J Nederkoorn⁴⁹, Carmen Barbato⁵⁰, Simone Browning^{51

52}, Kim Wiegertjes⁵³, Anil Man Tuladhar⁵³, Anne-Marie Mendyk⁵⁴, Sebastian Köhler⁵⁵, Robert van Oostenburgge⁵⁶, Ying Zhou⁵⁷, Chao Xu⁵⁷, Saima Hilal⁵⁸, Bibek Gyanwali⁵⁹, Christopher Chen⁵⁹, Min Lou⁵⁷, Julie Staals⁵⁶, Regis Bordet⁵⁴, Nagaendran Kandiah⁶⁰, Frank-Erik de Leeuw⁵³, Robert Simister^{51

52}, Jeroen Hendrikse⁶¹, Joanna Wardlaw^{62

63}, Peter Kelly⁶⁴, Felix Fluri⁴², Velandai Srikanth⁶⁵, David Calvet³⁸, Simon Jung⁴, Vincent I H Kwa⁶⁶, Eric E Smith³², Hideo Hara⁶⁷, Yusuke Yakushiji⁶⁸, Dilek Necioglu Orken⁶⁹, Franz Fazekas²⁴, Vincent Thijs^{70

71}, Ji-Hoe Heo¹⁹, Roland Veltkamp^{18

72}, Hakan Ay⁷³, Toshio Imaizumi¹⁶, Kui Kai Lau^{13

74}, Eric Jouvent^{75

76}, Kazunori Toyoda¹⁰, Sohei Yoshimura¹⁰, Hee-Joon Bae⁷⁷, Joan Martí-Fàbregas¹⁵, Luis Prats-Sánchez¹⁵, Philippe Lyrer², Jonathan Best^{51

52}, David Werring^{51

52}, Stefan T Engelter^{2

78}, Nils Peters^{2

78

79}; Microbleeds International Collaborative Network

Affiliations

¹ Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
² Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland.
³ Gerald Choa Neuroscience Institute, Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Science, Lau Tat-chuen Research Centre of Brain Degenerative Diseases in Chinese, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong.
⁴ Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
⁵ Department of Statistical Science, University College London, London, UK.
⁶ Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK, New Zealand Brain Research Institute, Christchurch, New Zealand.
⁷ Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
⁸ Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea.
⁹ Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
¹⁰ Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan.
¹¹ APHP, Lariboisière Hospital, Translational Neurovascular Centre, F-75475 Paris, France, FHU NeuroVasc, Université de Paris and INSERM U1141, Paris, France.
¹² Department of Neurology, University of Heidelberg/Mannheim Hospital, Mannheim, Germany.
¹³ Division of Neurology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
¹⁴ Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, Hong Kong.
¹⁵ Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain.
¹⁶ Department of Neurosurgery, Kushiro City General Hospital, Kushiro, Japan.
¹⁷ Departments of Neurology and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
¹⁸ Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
¹⁹ Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
²⁰ Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea.
²¹ Experimental Neurology, Department of Neurosciences, KU Leuven-University of Leuven, Leuven, Belgium.
²² VIB Center for Brain & Disease Research, Leuven, Belgium.
²³ Department of Neurology, University Hospitals Leuven, Leuven, Belgium.
²⁴ Department of Neurology, Medical University of Graz, Graz, Austria.
²⁵ Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
²⁶ Antalya Teaching and Research Hospital, Department of Radiology, University of Health Sciences Turkey, Antalya, Turkey.
²⁷ Sisli Hamidiye Etfal Teaching and Research Hospital, Department of Neurology, University of Health Sciences Turkey, Antalya, Turkey.
²⁸ Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
²⁹ Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
³⁰ Department of Radiology, Saga University Faculty of Medicine, Saga, Japan.
³¹ Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan.
³² Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
³³ Department of Neurology and Neurosurgery, University Medical Centre Utrecht and Utrecht University, Utrecht, The Netherlands.
³⁴ Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK.
³⁵ Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK.
³⁶ Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
³⁷ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
³⁸ GHU-Paris Psychiatrie et Neurosciences, Neurology Department and Stroke Unit, Sainte-Anne Hospital, and Université de Paris Cité, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France.
³⁹ GHU-Paris Psychiatrie et Neurosciences, Neuroradiology Department, Sainte-Anne Hospital, and Université Paris Cité, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France.
⁴⁰ Peninsula Clinical School, Peninsula Health, Monash University, Melbourne, Australia.
⁴¹ Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
⁴² Department of Neurology, University Hospital of Würzburg, Würzburg, Germany.
⁴³ Centre for Clinical Brain Sciences, Edinburgh Imaging, Edinburgh, UK.
⁴⁴ UK Dementia Institute at the University of Edinburgh, Edinburgh, UK.
⁴⁵ Centre for Rural Health, Institute for Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
⁴⁶ Acute Medical Unit and Department of Age-related Healthcare, Tallaght University Hospital, Dublin, Ireland.
⁴⁷ Department of Geriatric and Stroke Medicine, RCSI University of Medicine and Health Sciences Dublin, Ireland and Beaumont Hospital Dublin, Dublin, Ireland.
⁴⁸ Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
⁴⁹ Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
⁵⁰ Department of Neurology, University of Florence, Firenze, Italy.
⁵¹ Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK.
⁵² Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK.
⁵³ Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.
⁵⁴ University of Lille, Inserm, CHU de Lille. Lille Neuroscience & Cognition, Lille, France.
⁵⁵ Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.
⁵⁶ Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands.
⁵⁷ Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
⁵⁸ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
⁵⁹ Memory Aging & Cognition Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁶⁰ Dementia Research Centre (Singapore), Lee Kong Chian School of Medicine, Singapore, Singapore.
⁶¹ Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
⁶² Division of Neuroimaging Sciences, Edinburgh Imaging, Edinburgh, UK.
⁶³ UK Dementia Research Institute, University of Edinburgh and NHS Lothian, Edinburgh, UK.
⁶⁴ The Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin, Ireland.
⁶⁵ Peninsula Clinical School, Peninsula Health, Monash University, Melbourne, Australia, National Centre for Healthy Ageing, Melbourne, Australia.
⁶⁶ Department of Neurology, OLVG, Amsterdam, The Netherlands.
⁶⁷ Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan.
⁶⁸ Department of Neurology, Kansai Medical University, Hirakata, Japan.
⁶⁹ Department of Neurology, Istanbul Arel University, Istanbul, Turkey.
⁷⁰ Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.
⁷¹ A.A. Martinos Center for Biomedical Imaging, Departments of Neurology and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁷² Department of Neurology, Austin Health, Heidelberg, Australia.
⁷³ Department of Brain Sciences, Imperial College London, London, UK.
⁷⁴ State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Shatin, Hong Kong.
⁷⁵ Université de Paris-Assistance Publique Hôpitaux de Paris, Paris, France.
⁷⁶ Département de Neurologie, Hôpital Lariboisière, FHU NeuroVasc, INSERM NeuroDiderot U1141, Paris, France.
⁷⁷ Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
⁷⁸ Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland.
⁷⁹ Stroke Center, Klinik Hirslanden, Zürich, Switzerland.

PMID: 36928609
DOI: 10.1002/ana.26642

Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation

Yannie Soo et al. Ann Neurol. 2023 Jul.

. 2023 Jul;94(1):61-74.

doi: 10.1002/ana.26642. Epub 2023 Apr 17.

Authors

Affiliations

¹ Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
² Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland.
³ Gerald Choa Neuroscience Institute, Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Science, Lau Tat-chuen Research Centre of Brain Degenerative Diseases in Chinese, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong.
⁴ Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
⁵ Department of Statistical Science, University College London, London, UK.
⁶ Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK, New Zealand Brain Research Institute, Christchurch, New Zealand.
⁷ Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
⁸ Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea.
⁹ Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
¹⁰ Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan.
¹¹ APHP, Lariboisière Hospital, Translational Neurovascular Centre, F-75475 Paris, France, FHU NeuroVasc, Université de Paris and INSERM U1141, Paris, France.
¹² Department of Neurology, University of Heidelberg/Mannheim Hospital, Mannheim, Germany.
¹³ Division of Neurology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
¹⁴ Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, Hong Kong.
¹⁵ Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain.
¹⁶ Department of Neurosurgery, Kushiro City General Hospital, Kushiro, Japan.
¹⁷ Departments of Neurology and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
¹⁸ Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
¹⁹ Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
²⁰ Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea.
²¹ Experimental Neurology, Department of Neurosciences, KU Leuven-University of Leuven, Leuven, Belgium.
²² VIB Center for Brain & Disease Research, Leuven, Belgium.
²³ Department of Neurology, University Hospitals Leuven, Leuven, Belgium.
²⁴ Department of Neurology, Medical University of Graz, Graz, Austria.
²⁵ Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
²⁶ Antalya Teaching and Research Hospital, Department of Radiology, University of Health Sciences Turkey, Antalya, Turkey.
²⁷ Sisli Hamidiye Etfal Teaching and Research Hospital, Department of Neurology, University of Health Sciences Turkey, Antalya, Turkey.
²⁸ Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
²⁹ Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
³⁰ Department of Radiology, Saga University Faculty of Medicine, Saga, Japan.
³¹ Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan.
³² Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
³³ Department of Neurology and Neurosurgery, University Medical Centre Utrecht and Utrecht University, Utrecht, The Netherlands.
³⁴ Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK.
³⁵ Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK.
³⁶ Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
³⁷ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
³⁸ GHU-Paris Psychiatrie et Neurosciences, Neurology Department and Stroke Unit, Sainte-Anne Hospital, and Université de Paris Cité, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France.
³⁹ GHU-Paris Psychiatrie et Neurosciences, Neuroradiology Department, Sainte-Anne Hospital, and Université Paris Cité, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France.
⁴⁰ Peninsula Clinical School, Peninsula Health, Monash University, Melbourne, Australia.
⁴¹ Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
⁴² Department of Neurology, University Hospital of Würzburg, Würzburg, Germany.
⁴³ Centre for Clinical Brain Sciences, Edinburgh Imaging, Edinburgh, UK.
⁴⁴ UK Dementia Institute at the University of Edinburgh, Edinburgh, UK.
⁴⁵ Centre for Rural Health, Institute for Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
⁴⁶ Acute Medical Unit and Department of Age-related Healthcare, Tallaght University Hospital, Dublin, Ireland.
⁴⁷ Department of Geriatric and Stroke Medicine, RCSI University of Medicine and Health Sciences Dublin, Ireland and Beaumont Hospital Dublin, Dublin, Ireland.
⁴⁸ Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
⁴⁹ Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
⁵⁰ Department of Neurology, University of Florence, Firenze, Italy.
⁵¹ Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK.
⁵² Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK.
⁵³ Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.
⁵⁴ University of Lille, Inserm, CHU de Lille. Lille Neuroscience & Cognition, Lille, France.
⁵⁵ Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.
⁵⁶ Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands.
⁵⁷ Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
⁵⁸ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
⁵⁹ Memory Aging & Cognition Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁶⁰ Dementia Research Centre (Singapore), Lee Kong Chian School of Medicine, Singapore, Singapore.
⁶¹ Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
⁶² Division of Neuroimaging Sciences, Edinburgh Imaging, Edinburgh, UK.
⁶³ UK Dementia Research Institute, University of Edinburgh and NHS Lothian, Edinburgh, UK.
⁶⁴ The Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin, Ireland.
⁶⁵ Peninsula Clinical School, Peninsula Health, Monash University, Melbourne, Australia, National Centre for Healthy Ageing, Melbourne, Australia.
⁶⁶ Department of Neurology, OLVG, Amsterdam, The Netherlands.
⁶⁷ Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan.
⁶⁸ Department of Neurology, Kansai Medical University, Hirakata, Japan.
⁶⁹ Department of Neurology, Istanbul Arel University, Istanbul, Turkey.
⁷⁰ Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.
⁷¹ A.A. Martinos Center for Biomedical Imaging, Departments of Neurology and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁷² Department of Neurology, Austin Health, Heidelberg, Australia.
⁷³ Department of Brain Sciences, Imperial College London, London, UK.
⁷⁴ State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Shatin, Hong Kong.
⁷⁵ Université de Paris-Assistance Publique Hôpitaux de Paris, Paris, France.
⁷⁶ Département de Neurologie, Hôpital Lariboisière, FHU NeuroVasc, INSERM NeuroDiderot U1141, Paris, France.
⁷⁷ Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
⁷⁸ Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland.
⁷⁹ Stroke Center, Klinik Hirslanden, Zürich, Switzerland.

PMID: 36928609
DOI: 10.1002/ana.26642

Abstract

Objectives: Cerebral microbleeds are associated with the risks of ischemic stroke and intracranial hemorrhage, causing clinical dilemmas for antithrombotic treatment decisions. We aimed to evaluate the risks of intracranial hemorrhage and ischemic stroke associated with microbleeds in patients with atrial fibrillation treated with vitamin K antagonists, direct oral anticoagulants, antiplatelets, and combination therapy (i.e. concurrent oral anticoagulant and antiplatelet).

Methods: We included patients with documented atrial fibrillation from the pooled individual patient data analysis by the Microbleeds International Collaborative Network. Risks of subsequent intracranial hemorrhage and ischemic stroke were compared between patients with and without microbleeds, stratified by antithrombotic use.

Results: A total of 7,839 patients were included. The presence of microbleeds was associated with an increased relative risk of intracranial hemorrhage (adjusted hazard ratio [aHR] = 2.74, 95% confidence interval = 1.76-4.26) and ischemic stroke (aHR = 1.29, 95% confidence interval = 1.04-1.59). For the entire cohort, the absolute incidence of ischemic stroke was higher than intracranial hemorrhage regardless of microbleed burden. However, for the subgroup of patients taking combination of anticoagulant and antiplatelet therapy, the absolute risk of intracranial hemorrhage exceeded that of ischemic stroke in those with 2 to 4 microbleeds (25 vs 12 per 1,000 patient-years) and ≥ 11 microbleeds (94 vs 48 per 1,000 patient-years).

Interpretation: Patients with atrial fibrillation and high burden of microbleeds receiving combination therapy have a tendency of higher rate of intracranial hemorrhage than ischemic stroke, with potential for net harm. Further studies are needed to help optimize stroke preventive strategies in this high-risk group. ANN NEUROL 2023;94:61-74.

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References

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Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation

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Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation

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