Cerebral Microbleed Prevalence and Burden in NOAC vs VKA-Associated Intracerebral Hemorrhage
Lioutas VA, Goyal N, Katsanos A, Krogias C, Zand R, Sharma V, Varelas P, Malhotra K, Paciaroni M, Sharaf A, Chang Chang J, Kargiotis O, Pandhi A, Schroeder C, Tsantes A, Mehta C, Mitsias PD, Selim M, Alexandrov A, and Tsivgoulis G. Cerebral Microbleed Prevalence and Burden in NOAC vs VKA-Associated Intracerebral Hemorrhage. Eur Stroke J 2019; 4:460.
Eur Stroke J
Background and Aims: Vitamin-K antagonists (VKA) have been associated with elevated prevalence and incidence of cerebral microbleeds (CMBs). The association between non-vitamin K oral anticoagulants (NOACs) and CMBs is less well described. We undertook this observational study to describe differences in CMB burden in a cohort of anticoagulation- related intracerebral hemorrhage (ICH). Methods: From a multicenter cohort of 357 ICH patients, 89 (25 NOAC, 64 VKA) received MRI allowing identification of CMBs.We identified CMB burden both as a continuous number and dichotomized (cutoff of >5 vs. <5). Results: Both groups had comparable cardiovascular comorbidities and concomitant medications. NOAC-ICH patients were older [median age 78 (70-81) vs. 70 (60-77) years, p=0.005] with less frequent lobar ICH (28% vs 57.8% p=0.001). CMB prevalence was comparable (VKAICH: 51.6%, NOAC-ICH:48%). However, amongst patients with present CMB(s), NOAC-ICH had lower median CMB count 2(1-3) vs 7(4-11); p<0.001 and a significantly lower proportion of ≥5 CMBs (4.0% vs 31.2%, p=0.006). On multivariable logistic regression models, NOACICH was independently associated with lower odds (OR=0.10, 95%CI: 0.01,0.83) and 3T MRI field strength with higher odds (OR=6.42,95%CI: 1.96,21.03) of higher CMB burden ; the proportion of 3T MRI was evenly distributed between groups (39.1% vs 36%) Conclusions: CMB prevalence is similar in NOAC vs VKA-ICH. However, NOAC exposure was independently associated with lower CMB count and lower odds of a higher CMB burden. Given the association between CMB burden and future ICH risk, longitudinal follow up studies are necessary to delineate whether this association translates into reduced ICH recurrence risk.