Association of Anticoagulant Use With Hemorrhage Location and Etiology in Incident Spontaneous Intracerebral Hemorrhage.

IF 7.8 1区医学 Q1 CLINICAL NEUROLOGY

Stroke Pub Date : 2024-11-01 Epub Date: 2024-10-02 DOI:10.1161/STROKEAHA.124.048243

Mitch Wilson, Diego Incontri, Stephanie Vu, Sarah Marchina, Jia-Yi Wang, Alexander Andreev, Elizabeth Heistand, Filipa Carvalho, Magdy Selim, Vasileios-Arsenios Lioutas

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引用次数: 0

Abstract

Background: It is unknown whether hypertensive microangiopathy or cerebral amyloid angiopathy (CAA) predisposes more to anticoagulant-associated intracerebral hemorrhage (AA-ICH). The purpose of our study was to determine whether AA-ICH is associated with lobar location and probable CAA.

Methods: This was a cross-sectional analysis of patients with first-ever spontaneous ICH admitted to a tertiary hospital in Boston, between 2008 and 2023. Univariable and multivariable logistic regression were used to investigate the association between anticoagulation use and both lobar hemorrhage location and probable CAA on magnetic resonance imaging (MRI) by Boston Criteria 2.0 or computed tomography by Simplified Edinburgh Criteria.

Results: A total of 1104 patients (mean [SD] age, 73 [12]; 499 females [45.0%]) were included. Of the 1104 patients, 268 (24.3%) had AA-ICH: 148 (55.2%) with vitamin K antagonists and 107 (39.9%) with direct oral anticoagulants. Brain MRI was performed in 695 (63.0%) patients. The proportion of patients with lobar hemorrhage was not different between those with and without AA-ICH (121/268 [45.1%] versus 424/836 [50.7%]; odds ratio [OR], 0.80 [95% CI, 0.61-1.05]; P=0.113). Patients with AA-ICH were less likely to have probable CAA on MRI (17/146 [11.6%] versus 127/549 [23.1%]; OR, 0.44 [95% CI, 0.25-0.75]; P=0.002) and probable CAA on MRI or computed tomography if MRI not performed (27/268 [10.0%] versus 200/836 [23.9%]; OR, 0.36 [95% CI, 0.23-0.55]; P<0.001). Among patients with AA-ICH, there were no differences in the proportion with lobar hemorrhage (63/148 [42.6%] versus 46/107 [43.0%]; OR, 1.02 [95% CI, 0.62-1.68]; P=0.946) or probable CAA on MRI (10/72 [13.9%] versus 7/69 [10.1%]; OR, 0.70 [95% CI, 0.25-1.96]; P=0.495) between vitamin K antagonists and direct oral anticoagulant users.

Conclusions: AA-ICH was not associated with lobar hemorrhage location but was associated with reduced odds of probable CAA. These results suggest that hypertensive microangiopathy may predispose more toward incident AA-ICH than CAA and emphasize the importance of blood pressure control among anticoagulant users. These findings require replication in additional cohorts.

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自发性脑内出血患者使用抗凝剂与出血部位和病因的关系

背景：高血压微血管病变或脑淀粉样血管病变（CAA）是否更容易导致抗凝剂相关性脑出血（AA-ICH）尚不清楚。我们的研究旨在确定 AA-ICH 是否与脑叶位置和可能的 CAA 有关：这是一项横断面分析，研究对象是 2008 年至 2023 年期间波士顿一家三级医院收治的首次自发性 ICH 患者。方法：这是一项横断面分析，分析对象是波士顿三甲医院在 2008 年至 2023 年间收治的首次自发性 ICH 患者，采用单变量和多变量逻辑回归法研究抗凝治疗与根据波士顿标准 2.0 进行的磁共振成像（MRI）或根据简化爱丁堡标准进行的计算机断层扫描显示的叶状出血位置和可能的 CAA 之间的关系：共纳入 1104 名患者（平均 [SD] 年龄 73 [12]；女性 499 [45.0%]）。在 1104 名患者中，268 人（24.3%）患有 AA-ICH ：148 人（55.2%）使用维生素 K 拮抗剂，107 人（39.9%）使用直接口服抗凝剂。695名（63.0%）患者接受了脑磁共振成像检查。有 AA-ICH 和没有 AA-ICH 的患者脑叶出血的比例没有差异（121/268 [45.1%] 对 424/836 [50.7%]；几率比 [OR]，0.80 [95% CI，0.61-1.05]；P=0.113）。AA-ICH患者在磁共振成像中出现可能的CAA的可能性较低（17/146 [11.6%] 对 127/549 [23.1%]；OR，0.44 [95% CI，0.25-0.75]；P=0.002），如果未进行磁共振成像，在磁共振成像或计算机断层扫描中出现可能的CAA的可能性较低（27/268 [10.0%]对200/836[23.9%]；OR，0.36[95% CI，0.23-0.55]；PP=0.946）或MRI上的可能CAA（10/72[13.9%]对7/69[10.1%]；OR，0.70[95% CI，0.25-1.96]；P=0.495）：结论：AA-ICH与肺叶出血位置无关，但与可能发生CAA的几率降低有关。这些结果表明，高血压微血管病可能比CAA更容易导致AA-ICH的发生，并强调了抗凝剂使用者控制血压的重要性。这些研究结果需要在更多的队列中重复。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.