Cerebral Microbleed Prevalence and Burden in NOAC vs VKA-Associated Intracerebral Hemorrhage

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Conference Proceeding

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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.



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