Stroke Risk and Antithrombotic Treatment During Follow-up of Patients With Ischemic Stroke and Cortical Superficial Siderosis.
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Martí-Fàbregas Joan, Camps-Renom Pol, Best Jonathan G, Ramos-Pachon Anna, Guasch-Jiménez Marina, Martinez-Domeño Alejandro, Guisado-Alonso Daniel, Gómez-Ansón Beatriz M, Ambler Gareth, Wilson Duncan, Lee Keon-Joo, Lim Jae-Sung, Bae Hee-Joon, Shiozawa Masayuki, Koga Masatoshi, Toyoda Kazunori, Hennerici Michael G, Chabriat Hugues, Jouvent Eric, Wong Debbie Yuen Kwun, Mak Henry, Lau Kui Kai, Kim Young Dae, Song Tae-Jin, Heo Ji-Hoe, Eppinger Sebastian, Gattringer Thomas, Uysal Ender, Demirelli Derya Selçuk, Bornstein Natan, Ben Assayag Einor, Hallevi Hen, Molad Jeremy A, Nishihara Masashi, Tanaka Jun, Hara Hideo, Yakushiji Yusuke, Coutts Shelagh B, Smith Eric, Polymeris Alexandros A, Wagner Benjamin, Seiffge David, Lyrer Philippe A, Peters Nils, Engelter Stefan T, Al-Shahi Salman Rustam, Jäger Hans Rudolf, Lip Gregory Y H, Goeldlin Martina, Panos Leonidas, Karayiannis Christopher Charles, Phan Thanh G, Srikanth Velandai K, Christ Nicolas, Gunkel Sarah, Fluri Felix, Leung Thomas W, Soo Yannie O Y, Chu Winnie, Abrigo Jill, Barbato Carmen, Browning Simone, Simister Robert, Mendyk Anne-Marie, Bordet Régis, Hilal Saima, Gyanwali Bibek, Chen Christopher, Jung Simon, Necioglu Orken Dilek, Werring David, Prats-Sanchez Luis, Microbleeds International Collaborative Network (MICON)
Аннотация
METHODS: We retrospectively analyzed the Microbleeds International Collaborative Network (MICON) database. We selected patients with IS or TIA from cohorts who had MRI-assessed cSS, available data on antithrombotic treatments, recurrent cerebrovascular events (intracranial hemorrhage [ICrH], IS, or any stroke [ICrH or IS]), and mortality. We calculated incidence rates (IRs) and performed univariable and multivariable Cox regression analyses.
RESULTS: Of 12,669 patients (mean age 70.4 ± 12.3 years, 57.3% men), cSS was detected in 273 (2.2%) patients. During a mean follow-up of 24 ± 17 months, IS was more frequent than ICrH in both cSS (IR 57.1 vs 14.6 per 1,000 patient-years) and non-cSS (33.7 vs 6.3 per 1,000 patient-years) groups. Compared with the non-cSS group, cSS was associated with any stroke on multivariable analysis {IR 83 vs 42 per 1,000 patient-years, adjusted hazard ratio [HR] for cSS 1.62 (95% CI: 1.14-2.28; p = 0.006)}. This association was not significant in subgroups of patients treated with antiplatelet drugs (n = 6,554) or with anticoagulants (n = 4,044). Patients with cSS who were treated with both antiplatelet drugs and anticoagulants (n = 1,569) had a higher incidence of ICrH (IR 107.5 vs 4.9 per 1,000 patient-years, adjusted HR 13.26; 95% CI: 2.90-60.63; p = 0.001) and of any stroke (IR 198.8 vs 34.7 per 1,000 patient-years, adjusted HR 5.03; 95% CI: 2.03-12.44; p < 0.001) compared with the non-cSS group.
DISCUSSION: Patients with IS or TIA with cSS are at increased risk of stroke (ICrH or IS) during follow-up; the risk of IS exceeds that of ICrH for patients receiving antiplatelet or anticoagulant treatment alone, but the risk of ICrH exceeds that of IS in patients receiving both treatments. The findings suggest that either antiplatelet or anticoagulant treatment alone should not be avoided in patients with cSS, but combined antithrombotic therapy might be hazardous. Our findings need to be confirmed by randomized clinical trials.