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Zhao B, Yuan Y, Li Z, Chen Y, Gao Y, Yang B, Wu J, Jia W. Risk of intracranial hemorrhage in patients using anticoagulant therapy for atrial fibrillation after cerebral microbleeds combined with acute ischemic stroke: a meta-analysis. Front Neurol 2024; 15:1372231. [PMID: 38560733 PMCID: PMC10978779 DOI: 10.3389/fneur.2024.1372231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Objective To evaluate intracerebral hemorrhage (ICH) risk in patients with ischemic stroke (IS) and cerebral microbleeds (CMBs) undergoing anticoagulation therapy for non-valvular atrial fibrillation (AF). Methods We conducted a comprehensive search across multiple databases, including Embase, PubMed, Cochrane, UpToDate, Scopus, WOS, and SinoMed. The search covered observational literature published from each database inception until February 1, 2023. We analyzed the prevalence of CMBs during the follow-up period, compared future ICH risk between patients with and without baseline CMBs (CMBs presence/absence, ≧5 CMBs), and examined factors influencing ICH occurrence in patients with CMBs. Also studied recurrent stroke during anticoagulation therapy, the risk of future ICH when white matter hyperintensity (WMH) and CMBs coexist, and the effects of anticoagulants vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) on future ICH. Results We included 7 articles involving 5,134 participants. The incidence of CMBs was 24%; baseline CMBs were associated with an increased ICH risk compared to patients without CMBs. ICH-risk was more significant in patients with baseline ≥5 CMBs. After anticoagulant therapy, ICH risk was higher than that of recurrent IS. The risk of future ICH was significantly increased with anticoagulant VKAs compared with NOAC. Conclusion Anticoagulant therapy for ischemic stroke patients with non-valvular AF and CMBs increases future ICH risk. Discontinuing anticoagulation due to ICH risk should be avoided. NOACs are safe and effective for patients with CMBs and IS.
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Affiliation(s)
- Bingqing Zhao
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, China
| | - Ye Yuan
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, China
| | - Zheng Li
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, China
| | - Ying Chen
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, China
| | - Yali Gao
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, China
| | - Baoling Yang
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, China
| | - Jingyi Wu
- University of Glasgow, Glasgow, United Kingdom
| | - Weihua Jia
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, China
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Yamada SM, Tomita Y, Iwamoto N, Takeda R, Nakane M, Aso T, Takahashi M. Subcortical hemorrhage caused by cerebral amyloid angiopathy compared with hypertensive hemorrhage. Clin Neurol Neurosurg 2024; 236:108076. [PMID: 38128259 DOI: 10.1016/j.clineuro.2023.108076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/13/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Most published reports on lobular hemorrhage in cerebral amyloid angiopathy (CAA) include patients diagnosed only by imaging studies. This study analyzed patients with subcortical hemorrhage histologically diagnosed as CAA or non-CAA (hypertensive). METHODS This is a retrospective study analyzing data from 100 craniotomy cases. Tissue of hematoma cavity wall was collected for histological investigation in hematoma removal by surgery in patients with subcortical hemorrhage. Statistical analyses of blood pressure, hematoma location and volume, outcome, and mortality was performed in CAA and non-CAA groups. RESULTS There were 47 CAA and 53 non-CAA cases, and average age was significantly older in the CAA group (p < 0.01). Blood pressure was significantly lower (p < 0.01) but hematoma volume was significantly greater (p < 0.05) in the CAA group. Rebleeding occurred in two CAA cases and one non-CAA case, but no re-operations were required. Average score of modified Rankin Scale, which is used to measure the degree of disability in patients who have had a stroke, at three months after surgery was not significantly different between the two groups (CAA: 3.94 ± 1.28, non-CAA: 3.58 ± 1.50). There were seven deaths in the CAA and six in the non-CAA group, and intraventricular hemorrhage highly complicated in the death cases in both groups. In the CAA group, average age of the fatal cases was significantly older than that of the surviving cases (p < 0.05) and six cases demonstrated dementia before onset of hemorrhage. CONCLUSIONS Surgical removal of a subcortical hemorrhage caused by CAA is not contraindicated. However, age > 80 years, complication with intraventricular hemorrhage, hematoma volume ≥ 50 ml, and dementia before onset of hemorrhage contribute to high mortality, and craniotomy should be carefully considered for such patients. A limitation of this study is that comparison between CAA and non-CAA groups was performed in the patients with only surgically indicated ICH, and does not evaluate entire ICH cases with CAA. However, this study appropriately compared pathologically diagnosed CAA and non-CAA in patients with moderate to severe lobular ICH with surgical indications.
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Affiliation(s)
- Shoko Merrit Yamada
- Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Kanagawa, Japan.
| | - Yusuke Tomita
- Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Kanagawa, Japan
| | - Naotaka Iwamoto
- Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Kanagawa, Japan
| | - Ririko Takeda
- Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Kanagawa, Japan
| | - Makoto Nakane
- Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Kanagawa, Japan
| | - Tatsuya Aso
- Department of Diagnostic Pathology, Teikyo University Mizonokuchi Hospital, Kawasaki, Kanagawa, Japan
| | - Mikiko Takahashi
- Department of Diagnostic Pathology, Teikyo University Mizonokuchi Hospital, Kawasaki, Kanagawa, Japan
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Kubacka M, Zietz A, Schaedelin S, Polymeris AA, Hert L, Lieb J, Wagner B, Seiffge D, Traenka C, Altersberger VL, Dittrich T, Fladt J, Fisch U, Thilemann S, De Marchis GM, Gensicke H, Bonati LH, Lyrer P, Engelter ST, Peters N. Global Cortical Atrophy Is Associated with an Unfavorable Outcome in Stroke Patients on Oral Anticoagulation. Cerebrovasc Dis 2022; 52:495-502. [PMID: 36513036 PMCID: PMC10627484 DOI: 10.1159/000527739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Measures of cerebral small vessel disease (cSVD), such as white matter hyperintensities (WMH) and cerebral microbleeds (CMB), are associated with an unfavorable clinical course in stroke patients on oral anticoagulation (OAC) for atrial fibrillation (AF). Here, we investigated whether similar findings can be observed for global cortical atrophy (GCA). METHODS Registry-based prospective observational study of 320 patients treated with OAC following AF stroke. Patients underwent magnetic resonance imaging (MRI) allowing assessment of GCA. Using the simplified visual Pasquier scale, the severity of GCA was categorized as follows: 0: no atrophy, 1: mild atrophy; 2: moderate atrophy, and 3: severe atrophy. Using adjusted logistic and Cox regression analysis, we investigated the association of GCA using a composite outcome measure, comprising: (i) recurrent acute ischemic stroke (IS); (ii) intracranial hemorrhage (ICH); and (iii) death. RESULTS In our time to event analysis after adjusting for potential confounders (i.e., WMH, CMB, age, sex, diabetes, arterial hypertension, coronary heart disease, hyperlipidemia, and antiplatelet use), GCA was associated with an increased risk for the composite outcome in all three degrees of atrophy (grade 1: aHR 3.95, 95% CI 1.34-11.63, p = 0.013; grade 2: aHR 3.89, 95% CI 1.23-12.30, p = 0.021; grade 3: aHR 4.16, 95% CI 1.17-14.84, p = 0.028). CONCLUSION GCA was associated with our composite outcome also after adjusting for other cSVD markers (i.e., CMB, WMH) and age, indicating that GCA may potentially serve as a prognostic marker for stroke patients with atrial fibrillation on oral anticoagulation.
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Affiliation(s)
- Marta Kubacka
- Stroke Center, Klinik Hirslanden, Zürich, Switzerland
- University of Basel, Basel, Switzerland
| | - Annaelle Zietz
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland,
| | - Sabine Schaedelin
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Alexandros A Polymeris
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Lisa Hert
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Johanna Lieb
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Benjamin Wagner
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - David Seiffge
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology and Stroke Center, Inselspital, Bern, Switzerland
| | - Christopher Traenka
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Valerian L Altersberger
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Tolga Dittrich
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Joachim Fladt
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Urs Fisch
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sebastian Thilemann
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stefan T Engelter
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Nils Peters
- Stroke Center, Klinik Hirslanden, Zürich, Switzerland
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
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Lansberg MG, Wintermark M, Kidwell CS, Albers GW. Magnetic Resonance Imaging of Cerebrovascular Diseases. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Social Determinants of Health Attenuate the Relationship Between Race and Ethnicity and White Matter Hyperintensity Severity but not Microbleed Presence in Patients with Intracerebral Hemorrhage. Neurocrit Care 2021; 36:955-963. [PMID: 34918215 DOI: 10.1007/s12028-021-01403-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The association between race and ethnicity and microvascular disease in patients with intracerebral hemorrhage (ICH) is unclear. We hypothesized that social determinants of health (SDOHs) mediate the relationship between race and ethnicity and severity of white matter hyperintensities (WMHs) and microbleeds in patients with ICH. METHODS We performed a retrospective observational cohort study of patients with ICH at two tertiary care hospitals between 2013 and 2020 who underwent magnetic resonance imaging of the brain. Magnetic resonance imaging scans were evaluated for the presence of microbleeds and WMH severity (defined by the Fazekas scale; moderate to severe WMH defined as Fazekas scores 3-6). We assessed for associations between sex, race and ethnicity, employment status, median household income, education level, insurance status, and imaging biomarkers of microvascular disease. A mediation analysis was used to investigate the influence of SDOHs on the associations between race and imaging features. We assessed the relationship of all variables with discharge outcomes. RESULTS We identified 233 patients (mean age 62 [SD 16]; 48% female) with ICH. Of these, 19% were Black non-Hispanic, 32% had a high school education or less, 21% required an interpreter, 11% were unemployed, and 6% were uninsured. Moderate to severe WMH, identified in 114 (50%) patients, was associated with age, Black non-Hispanic race and ethnicity, highest level of education, insurance status, and history of hypertension, hyperlipidemia, or diabetes (p < 0.05). In the mediation analysis, the proportion of the association between Black non-Hispanic race and ethnicity and the Fazekas score that was mediated by highest level of education was 65%. Microbleeds, present in 130 (57%) patients, was associated with age, highest level of education, and history of diabetes or hypertension (p < 0.05). Age, highest level of education, insurance status, and employment status were associated with discharge modified Rankin Scale scores of 3-6, but race and ethnicity was not. CONCLUSIONS The association between Black non-Hispanic race and ethnicity and moderate to severe WMH lost significance after we adjusted for highest level of education, suggesting that SDOHs may mediate the association between race and ethnicity and microvascular disease.
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6
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Melmed KR, Cao M, Dogra S, Zhang R, Yaghi S, Lewis A, Jain R, Bilaloglu S, Chen J, Czeisler BM, Raz E, Lord A, Berger JS, Frontera JA. Risk factors for intracerebral hemorrhage in patients with COVID-19. J Thromb Thrombolysis 2021; 51:953-960. [PMID: 32968850 PMCID: PMC7511245 DOI: 10.1007/s11239-020-02288-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 11/30/2022]
Abstract
Intracerebral hemorrhage (ICH) can be a devastating complication of coronavirus disease (COVID-19). We aimed to assess risk factors associated with ICH in this population. We performed a retrospective cohort study of adult patients admitted to NYU Langone Health system between March 1 and April 27 2020 with a positive nasopharyngeal swab polymerase chain reaction test result and presence of primary nontraumatic intracranial hemorrhage or hemorrhagic conversion of ischemic stroke on neuroimaging. Patients with intracranial procedures, malignancy, or vascular malformation were excluded. We used regression models to estimate odds ratios and 95% confidence intervals (OR, 95% CI) of the association between ICH and covariates. We also used regression models to determine association between ICH and mortality. Among 3824 patients admitted with COVID-19, 755 patients had neuroimaging and 416 patients were identified after exclusion criteria were applied. The mean (standard deviation) age was 69.3 (16.2), 35.8% were women, and 34.9% were on therapeutic anticoagulation. ICH occurred in 33 (7.9%) patients. Older age, non-Caucasian race, respiratory failure requiring mechanical ventilation, and therapeutic anticoagulation were associated with ICH on univariate analysis (p < 0.01 for each variable). In adjusted regression models, anticoagulation use was associated with a five-fold increased risk of ICH (OR 5.26, 95% CI 2.33-12.24, p < 0.001). ICH was associated with increased mortality (adjusted OR 2.6, 95 % CI 1.2-5.9). Anticoagulation use is associated with increased risk of ICH in patients with COVID-19. Further investigation is required to elucidate underlying mechanisms and prevention strategies in this population.
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Affiliation(s)
- Kara R Melmed
- Department of Neurology, New York University Langone Health, New York, NY, USA.
- Department of Neurosurgery, New York University Langone Health, New York, NY, USA.
| | - Meng Cao
- Department of Medicine, New York University Langone Health, New York, NY, USA
| | - Siddhant Dogra
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Ruina Zhang
- Department of Medicine, New York University Langone Health, New York, NY, USA
| | - Shadi Yaghi
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Ariane Lewis
- Department of Neurology, New York University Langone Health, New York, NY, USA
- Department of Neurosurgery, New York University Langone Health, New York, NY, USA
| | - Rajan Jain
- Department of Neurosurgery, New York University Langone Health, New York, NY, USA
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Seda Bilaloglu
- Department of Population Health, New York University Langone Health, New York, NY, USA
| | - Ji Chen
- Department of Population Health, New York University Langone Health, New York, NY, USA
| | - Barry M Czeisler
- Department of Neurology, New York University Langone Health, New York, NY, USA
- Department of Neurosurgery, New York University Langone Health, New York, NY, USA
| | - Eytan Raz
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Aaron Lord
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Jeffrey S Berger
- Department of Cardiology, New York University Langone Health, New York, NY, USA
| | - Jennifer A Frontera
- Department of Neurology, New York University Langone Health, New York, NY, USA
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7
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Zhang Y, Huang L, Wang D, Ren P, Hong Q, Kang D. The ROBINS-I and the NOS had similar reliability but differed in applicability: A random sampling observational studies of systematic reviews/meta-analysis. J Evid Based Med 2021; 14:112-122. [PMID: 34002466 DOI: 10.1111/jebm.12427] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 02/07/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE There is a lack of evidence on the usage of the quality assessment tool-the Risk Of Bias In Nonrandomized Studies-of Interventions (ROBINS-I). This article aimed to measure the reliability, criterion validity, and feasibility of the ROBINS-I and the Newcastle-Ottawa Scale (NOS). METHODS A sample of systematic reviews or meta-analyses of observational studies were selected from Medline (2013-2017) and assessed by two reviewers using ROBINS-I and the NOS. We reported on reliability in terms of the first-order agreement coefficient (AC1) statistic. Correlation coefficient statistic was used to explore the criterion validity of the ROBINS-I. We compared the feasibility of the ROBINS-I and NOS by recording the time to complete an assessment and the instances where assessing was difficult. RESULTS Five systematic reviews containing 41 cohort studies were finally included. Interobserver agreement on the individual domain of the ROBINS-I as well as the NOS was substantial with a mean AC1 statistic of 0.67 (95% CI: 0.50-0.83) and 0.73 (95% CI: 0.65-0.81), respectively. The criterion validity of the ROBNS-I was moderate (K = 0.52) against NOS. The time in assessing a single study by ROBINS-I varied from 7 hours initially to 3 hours compared with 30 minutes for the NOS. Both reviewers rated "bias due to departure from the intended interventions" the most time-consuming domain in the ROBINS-I, items in the NOS were equal. CONCLUSIONS The ROBINS-I and the NOS seem to provide the same reliability but vary in applicability. The over-complicated feature of ROBINS-I may limit its usage and a simplified version is needed.
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Affiliation(s)
- Yuhui Zhang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Litao Huang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dandan Wang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Pengwei Ren
- Clinical Research Center for Respiratory Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi Hong
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Deying Kang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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8
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Choi KH, Kim JH, Lee C, Kim JM, Kang KW, Kim JT, Choi SM, Park MS, Cho KH. Microbleeds and Outcome in Patients With Acute Ischemic Stroke and Atrial Fibrillation Taking Anticoagulants. Stroke 2020; 51:3514-3522. [DOI: 10.1161/strokeaha.120.030300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background and Purpose:
We investigated the impact of the presence, burden, and location of cerebral microbleeds (CMBs) on the risk of major adverse cerebrovascular and cardiovascular events (MACCE) in patients with acute ischemic stroke and atrial fibrillation treated with oral anticoagulants (OACs). We also examined whether the clinical effect of CMBs differs according to the type of OACs.
Methods:
A total of 1742 patients with acute ischemic stroke and atrial fibrillation treated with OACs were enrolled in this cohort study. The primary composite outcome was the occurrence of MACCE (a composite of stroke, acute myocardial infarction, or vascular death) over a 2-year period according to CMB status.
Results:
CMB presence was significantly associated with the risk of future MACCE (hazard ratio, 1.89 [95% CI, 1.23–2.88];
P
=0.003) after adjustment for confounders in patients with acute ischemic stroke and atrial fibrillation taking OACs. Patients with exactly 1 CMB had a similar rate of MACCE compared with those without CMBs (
P
=0.461). However, patients with multiple CMBs (≥2), particularly high burden CMBs (≥5), had a significantly higher proportion of MACCE. Both CMB-positive groups with lobar and deep CMB had more frequent MACCE than the CMB-negative group, and the rate of MACCE was not different according to CMB location. In patients treated with warfarin, CMB was significantly associated with a risk of MACCE (
P
=0.002), but not in patients treated with direct OACs (
P
=0.517).
Conclusions:
The study results indicate that the risk of future MACCE increased with increasing CMB burden in patients with AIS and atrial fibrillation taking OACs, while the anatomic location of CMBs did not influence the risk of future MACCE. This risk seemed to be more apparent in patients taking warfarin.
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Affiliation(s)
- Kang-Ho Choi
- Department of Neurology (K.-H. Choi, J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H. Cho), Chonnam National University Medical School and Hospital, Gwangju, Korea
- Department of Neurology, Chonnam National University Hwasun Hospital, Korea (K.-H. Choi, J.-M.K., K.-W.K.)
| | - Ja-Hae Kim
- Department of Nuclear Medicine, Molecular Imaging Center (J.-H.K.), Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Changho Lee
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Korea (C.L.)
| | - Jae-Myung Kim
- Department of Neurology (K.-H. Choi, J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H. Cho), Chonnam National University Medical School and Hospital, Gwangju, Korea
- Department of Neurology, Chonnam National University Hwasun Hospital, Korea (K.-H. Choi, J.-M.K., K.-W.K.)
| | - Kyung-Wook Kang
- Department of Neurology (K.-H. Choi, J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H. Cho), Chonnam National University Medical School and Hospital, Gwangju, Korea
- Department of Neurology, Chonnam National University Hwasun Hospital, Korea (K.-H. Choi, J.-M.K., K.-W.K.)
| | - Joon-Tae Kim
- Department of Neurology (K.-H. Choi, J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H. Cho), Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Seong-Min Choi
- Department of Neurology (K.-H. Choi, J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H. Cho), Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Man-Seok Park
- Department of Neurology (K.-H. Choi, J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H. Cho), Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Ki-Hyun Cho
- Department of Neurology (K.-H. Choi, J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H. Cho), Chonnam National University Medical School and Hospital, Gwangju, Korea
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9
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Gutiérrez-Zúñiga R, Rigual R, Torres-Iglesias G, Sánchez-Velasco S, Alonso de Leciñana M, Masjuan J, Álvarez Velasco R, Navas I, Izquierdo-Esteban L, Fernández-Ferro J, Rodríguez-Pardo J, Ruiz-Ares G, Zapata-Wainberg G, Fuentes B, Díez-Tejedor E. Long-Term Anticoagulation in Secondary Ischemic Stroke Prevention: The Prospective Multicenter RESTAIC Registry. Front Neurol 2020; 11:575634. [PMID: 33193025 PMCID: PMC7641639 DOI: 10.3389/fneur.2020.575634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: Oral anticoagulation (OAC) for secondary stroke prevention is recommended in atrial fibrillation (AF) and other sources of cardioembolic stroke. Our objectives were to explore the differences in ischemic and hemorrhagic events when using OAC for secondary stroke prevention according to the type of anticoagulant treatment and to analyze the number and reasons for OAC switches during long-term follow-up. Methods: Ischemic stroke (IS) patients who were discharged on OAC for secondary stroke prevention from January 2014 to October 2017 were recruited in a prospective, multicenter, hospital-based registry. Follow-up at 3 months was scheduled at the outpatient clinic with subsequent annual phone interviews for 3 years. Patients were classified into three study groups according to OAC at discharge: Vitamin K antagonist (VKA), Factor Xa inhibitor (FXa), or direct thrombin inhibitor (DTI). We compared stroke recurrences, intracranial hemorrhage, major bleeding, and all-cause mortality during the follow-up. We recorded any switches in OAC and the main reasons for the change. Results: A total of 241 patients were included. An anticoagulant was indicated in the presence of a source of cardioembolic stroke in 240 patients (99.6%) and lupus plus antiphospholipid syndrome in one patient. Up to 86 patients (35.6%) were on OAC before the index stroke; in 71 (82.5%) of them, this was VKA. At hospital discharge, 105 were treated with FXa (43.8%), 96 with VKA (39.6%), and 40 with DTI (16.6%). The cumulative incidences at 3 years were 17% for stroke recurrence, 1.6% for intracranial hemorrhage, 4.9% for major hemorrhage, and 22.8% for all-cause mortality, with no differences among the OAC groups in any outcomes. During the follow-up, 40 OAC switches were recorded (63% of them to FXa), mostly due to stroke recurrence. Conclusion: Long-term OAC in secondary stroke prevention is associated with a lower frequency of bleeding complications than stroke recurrences. No differences between anticoagulant drugs were found in any of the analyzed outcomes. The main cause for OAC switch during follow-up was stroke recurrence.
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Affiliation(s)
- Raquel Gutiérrez-Zúñiga
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ricardo Rigual
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Gabriel Torres-Iglesias
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Sara Sánchez-Velasco
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Alonso de Leciñana
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jaime Masjuan
- Departamento de Medicina, Facultad de Medicina, Servicio de Neurología, H Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Rodrigo Álvarez Velasco
- Departamento de Medicina, Facultad de Medicina, Servicio de Neurología, H Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Inmaculada Navas
- Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - José Fernández-Ferro
- Neurology Department and Stroke Unit, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Jorge Rodríguez-Pardo
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Gerardo Ruiz-Ares
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Blanca Fuentes
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Exuperio Díez-Tejedor
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
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10
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Abstract
With the elder proportion increasing and the antithrombotic agents widely using as well as the newly magnetic resonance imaging sequence emerging, the detection rate of cerebral microbleed (CMB) is gradually raising in recent years. As we all know that CMB mainly reflects the severity of deeply small vessel lesions, which predicts hemorrhagic transformation. Whereby, to some patients with both CMB and remarkable antithrombotic indication, treatment becomes a dilemma. We have to face the challenge of weighing the pros and cons of both drug indication and bleeding risk when making a proper decision for patients. This study summarized recent advance on CMB diagnosis and treatment, to provide a useful reference to physicians in their clinical practice.
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11
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Hert L, Polymeris AA, Schaedelin S, Lieb J, Seiffge DJ, Traenka C, Fladt J, Thilemann S, Gensicke H, De Marchis GM, Bonati L, Lyrer P, Engelter ST, Peters N. Small vessel disease is associated with an unfavourable outcome in stroke patients on oral anticoagulation. Eur Stroke J 2019; 5:63-72. [PMID: 32232171 DOI: 10.1177/2396987319888016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 10/13/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Cerebral small vessel disease is an important cause for both ischaemic stroke and intracranial haemorrhage. To date, knowledge on the impact of small vessel disease on the clinical course in stroke patients treated with oral anticoagulation for atrial fibrillation is limited. Patients and Methods Registry-based prospective observational study of 320 patients (aged 78.2 ± 9.2 years) treated with anticoagulation following atrial fibrillation stroke. Patients underwent standardised magnetic-resonance-imaging assessing measures of small vessel disease, including cerebral microbleeds and white matter hyperintensities. Median follow-up was 754 (interquartile range = [708-828]) days. Using adjusted logistic and Cox regression, we assessed the association of imaging measures with clinical outcome including recurrent ischaemic stroke, intracranial haemorrhage and death and assessed disability (modified Rankin Scale). Results Overall, recurrent ischaemic stroke was more common than intracranial haemorrhage (22 versus 8, respectively). Cerebral microbleeds were related to an increased risk of the composite endpoint (ischaemic stroke, intracranial haemorrhage, death: odds ratio (OR) 2.05, 95% confidence interval (CI) 1.27-3.31; P = 0.003), as were white matter hyperintensities (OR 2.00, 95%CI 1.23-3.27, P = 0.005). This was also true in time-to-event analysis (cerebral microbleeds: HR 2.31, 95%CI 1.39-3.52; P < 0.001; white matter hyperintensities: HR 1.99, 95%CI 1.20-3.17; P = 0.007). Both measures were associated with an increased risk for recurrent ischaemic stroke (cerebral microbleeds: HR 4.42, 95%CI 1.07-18.20; P = 0.04; white matter hyperintensities: HR 5.27, 95%CI 1.08-25.79, P = 0.04) and intracranial haemorrhage (cerebral microbleeds: HR 2.43, 95%CI 1.04-5.69; P = 0.04; white matter hyperintensities: HR 2.57, 95%CI 1.11-5.98, P = 0.03). Furthermore, confluent white matter hyperintensities were associated with increased disability (OR 4.03; 95%CI 2.16-7.52; P < 0.001) and mortality (HR 1.81, 95%CI 1.04-3.14, P = 0.04). Discussion and conclusion In atrial fibrillation stroke patients treated with oral anticoagulation, small vessel disease is associated with an unfavourable outcome. The presence of microbleeds indicated a risk higher for recurrent ischaemic stroke than for intracranial haemorrhage.
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Affiliation(s)
- Lisa Hert
- Department of Neurology and Stroke Center, University Hospital and University of Basel, Switzerland
| | - Alexandros A Polymeris
- Department of Neurology and Stroke Center, University Hospital and University of Basel, Switzerland
| | | | - Johanna Lieb
- Department of Neuroradiology, University Hospital and University of Basel, Switzerland
| | - David J Seiffge
- Department of Neurology and Stroke Center, University Hospital and University of Basel, Switzerland
| | - Christopher Traenka
- Department of Neurology and Stroke Center, University Hospital and University of Basel, Switzerland
| | - Joachim Fladt
- Department of Neurology and Stroke Center, University Hospital and University of Basel, Switzerland
| | - Sebastian Thilemann
- Department of Neurology and Stroke Center, University Hospital and University of Basel, Switzerland
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University Hospital and University of Basel, Switzerland.,Neurology and Neurorehabilitation, University Department for Medicine of Aging, Felix Platter-Hospital and University of Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital and University of Basel, Switzerland
| | - Leo Bonati
- Department of Neurology and Stroke Center, University Hospital and University of Basel, Switzerland
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University Hospital and University of Basel, Switzerland
| | - Stefan T Engelter
- Department of Neurology and Stroke Center, University Hospital and University of Basel, Switzerland.,Neurology and Neurorehabilitation, University Department for Medicine of Aging, Felix Platter-Hospital and University of Basel, Switzerland
| | - Nils Peters
- Department of Neurology and Stroke Center, University Hospital and University of Basel, Switzerland.,Neurology and Neurorehabilitation, University Department for Medicine of Aging, Felix Platter-Hospital and University of Basel, Switzerland
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12
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Herm J, Schurig J, Martinek MR, Höltgen R, Schirdewan A, Kirchhof P, Wieczorek M, Pürerfellner H, Heuschmann PU, Fiebach JB, Haeusler KG. MRI-detected brain lesions in AF patients without further stroke risk factors undergoing ablation - a retrospective analysis of prospective studies. BMC Cardiovasc Disord 2019; 19:58. [PMID: 30871479 PMCID: PMC6419420 DOI: 10.1186/s12872-019-1035-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 02/27/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) without other stroke risk factors is assumed to have a low annual stroke risk comparable to patients without AF. Therefore, current clinical guidelines do not recommend oral anticoagulation for stroke prevention of AF in patients without stroke risk factors. We analyzed brain magnetic resonance imaging (MRI) imaging to estimate the rate of clinically inapparent ("silent") ischemic brain lesions in these patients. METHODS We pooled individual patient-level data from three prospective studies comprising stroke-free patients with symptomatic AF. All study patients underwent brain MRI within 24-48 h before planned left atrial catheter ablation. MRIs were analyzed by a neuroradiologist blinded to clinical data. RESULTS In total, 175 patients (median age 60 (IQR 54-67) years, 32% female, median CHA2DS2-VASc = 1 (IQR 0-2), 33% persistent AF) were included. In AF patients without or with at least one stroke risk factor, at least one silent ischemic brain lesion was observed in 4 (8%) out of 48 and 10 (8%) out of 127 patients, respectively (p > 0.99). Presence of silent ischemic brain lesions was related to age (p = 0.03) but not to AF pattern (p = 0.77). At least one cerebral microbleed was detected in 5 (13%) out of 30 AF patients without stroke risk factors and 25 (25%) out of 108 AF patients with stroke risk factors (p = 0.2). Presence of cerebral microbleeds was related to male sex (p = 0.04) or peripheral artery occlusive disease (p = 0.03). CONCLUSION In patients with symptomatic AF scheduled for ablation, brain MRI detected silent ischemic brain lesions in approximately one in 12 patients, and microbleeds in one in 5 patients. The prevalence of silent ischemic brain lesions did not differ in AF patients with or without further stroke risk factors.
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Affiliation(s)
- Juliane Herm
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Schurig
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin R Martinek
- Department of Cardiology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Reinhard Höltgen
- Department of Cardiology and Electrophysiology, St. Agnes-Hospital Bocholt, Bocholt, Germany
| | | | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Marcus Wieczorek
- Department of Cardiology and Electrophysiology, St. Agnes-Hospital Bocholt, Bocholt, Germany.,Witten/Herdecke University, School of Medicine, Witten, Germany
| | | | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Karl Georg Haeusler
- Department of Neurology, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11 97080, Würzburg, Germany.
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13
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Chen X, Wang J, Shan Y, Cai W, Liu S, Hu M, Liao S, Huang X, Zhang B, Wang Y, Lu Z. Cerebral small vessel disease: neuroimaging markers and clinical implication. J Neurol 2018; 266:2347-2362. [PMID: 30291424 DOI: 10.1007/s00415-018-9077-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 12/28/2022]
Abstract
Cerebral small vessel disease (CSVD) is a broad category of cerebrovascular diseases which primarily affect the perforating arterioles, capillaries and venules with multiple distinct etiologies. In spite of distinctive pathogenesis, CSVD shares similar neuroimaging markers, including recent small subcortical infarct, lacune of presumed vascular origin, white matter hyperintensity of presumed vascular origin, perivascular space and cerebral microbleeds. The radiological features of neuroimaging markers are indicative for etiological analysis. Furthermore, in sporadic arteriosclerotic pathogenesis associated CSVD, the total CSVD burden is a significant predictor for stroke events, global cognitive impairment, psychiatric disorders and later life quality. This review aims to summarize the radiological characteristics as well as the clinical implication of CSVD markers and neuroimaging interpretation for CSVD symptomatology.
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Affiliation(s)
- Xiaodong Chen
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Jihui Wang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, No.600 Tian He Road, Guangzhou, 510630, Guangdong, China
| | - Yilong Shan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Wei Cai
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Sanxin Liu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Mengyan Hu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Siyuan Liao
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Xuehong Huang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Bingjun Zhang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Yuge Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China.
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14
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Zapata-Wainberg G, Masjuan J, Quintas S, Ximénez-Carrillo Á, García Pastor A, Martínez Zabaleta M, Cardona P, Freijo Guerrero MM, Llull L, Benavente Fernández L, Castellanos Rodrigo M, Egido J, Serena J, Vivancos J. The neurologist's approach to cerebral infarct and transient ischaemic attack in patients receiving anticoagulant treatment for non-valvular atrial fibrillation: ANITA-FA study. Eur J Neurol 2018; 26:230-237. [DOI: 10.1111/ene.13792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 08/17/2018] [Indexed: 12/18/2022]
Affiliation(s)
- G. Zapata-Wainberg
- Neurology Department; Hospital Universitario de La Princesa; Instituto de Investigación Sanitaria Princesa; Madrid Spain
| | - J. Masjuan
- Neurology Department; Hospital Universitario Ramón y Cajal; Red INVICTUS PLUS; Departamento de Medicina; Universidad de Alcalá (IRYCIS); Madrid Spain
| | - S. Quintas
- Neurology Department; Hospital Universitario de La Princesa; Instituto de Investigación Sanitaria Princesa; Madrid Spain
| | - Á. Ximénez-Carrillo
- Neurology Department; Hospital Universitario de La Princesa; Instituto de Investigación Sanitaria Princesa; Madrid Spain
| | - A. García Pastor
- Neurology Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | | | - P. Cardona
- Neurology Department; Hospital Universitari de Bellvitge; Barcelona Spain
| | | | - L. Llull
- Neurology Department; Hospital Universitari Clinic; Barcelona Spain
| | | | | | - J. Egido
- Hospital Clínico Universitario San Carlos; Madrid Spain
| | - J. Serena
- Neurology Department; Hospital Universitario Dr Josep Trueta; Girona Spain
| | - J. Vivancos
- Neurology Department; Hospital Universitario de La Princesa; Red INVICTUS PLUS; Instituto de Investigación Sanitaria La Princesa; Madrid Spain
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15
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Weber SA, Patel RK, Lutsep HL. Cerebral amyloid angiopathy: diagnosis and potential therapies. Expert Rev Neurother 2018; 18:503-513. [DOI: 10.1080/14737175.2018.1480938] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Stewart A. Weber
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Ranish K. Patel
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Helmi L. Lutsep
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
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16
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Shoamanesh A, Charidimou A, Sharma M, Hart RG. Should Patients With Ischemic Stroke or Transient Ischemic Attack With Atrial Fibrillation and Microbleeds Be Anticoagulated? Stroke 2017; 48:3408-3412. [DOI: 10.1161/strokeaha.117.018467] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/05/2017] [Accepted: 09/29/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Ashkan Shoamanesh
- From the Department of Medicine, Division of Neurology, McMaster University, Hamilton, Ontario, Canada (A.S., M.S., R.G.H.); Stroke and Cognition Program, Population Health Research Institute, Hamilton, Ontario, Canada (A.S., M.S., R.G.H.); and Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (A.C.)
| | - Andreas Charidimou
- From the Department of Medicine, Division of Neurology, McMaster University, Hamilton, Ontario, Canada (A.S., M.S., R.G.H.); Stroke and Cognition Program, Population Health Research Institute, Hamilton, Ontario, Canada (A.S., M.S., R.G.H.); and Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (A.C.)
| | - Mukul Sharma
- From the Department of Medicine, Division of Neurology, McMaster University, Hamilton, Ontario, Canada (A.S., M.S., R.G.H.); Stroke and Cognition Program, Population Health Research Institute, Hamilton, Ontario, Canada (A.S., M.S., R.G.H.); and Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (A.C.)
| | - Robert G. Hart
- From the Department of Medicine, Division of Neurology, McMaster University, Hamilton, Ontario, Canada (A.S., M.S., R.G.H.); Stroke and Cognition Program, Population Health Research Institute, Hamilton, Ontario, Canada (A.S., M.S., R.G.H.); and Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (A.C.)
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17
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Singh A, Hussain S, Najmi AK. Number of studies, heterogeneity, generalisability, and the choice of method for meta-analysis. J Neurol Sci 2017; 381:347. [PMID: 28967410 DOI: 10.1016/j.jns.2017.09.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/17/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Ambrish Singh
- 36-H, Pocket A3, Mayur Vihar Phase-III, New Delhi, India.
| | - Salman Hussain
- (Department of Pharmaceutical Medicine (Division of Pharmacology), School of Pharmaceutical Education and Research, Jamia Hamdard (Hamdard University), New Delhi, India)
| | - Abul Kalam Najmi
- (Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard (Hamdard University), New Delhi, India)
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18
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Charidimou A, Boulouis G, Shams S, Calvet D, Shoamanesh A. Meta-analysis methodology in the microbleeds field: The relevance of the clinical question and study quality in choosing the most appropriate model. J Neurol Sci 2017; 381:348-349. [PMID: 28947333 DOI: 10.1016/j.jns.2017.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/17/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Andreas Charidimou
- Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA.
| | - Gregoire Boulouis
- Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Department of Neuroradiology, Paris, France
| | - Sara Shams
- Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - David Calvet
- Department of Neurology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, DHU Neurovasc Sorbonne Paris Cité, INSERM U894, Paris, France
| | - Ashkan Shoamanesh
- Department of Medicine (Neurology), McMaster University and Population Health Research Institute, Hamilton, Ontario L8L 2X2, Canada
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