RT Journal Article
T1 MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation.
A1 Martí-Fàbregas, Joan
A1 Medrano-Martorell, Santiago
A1 Merino, Elisa
A1 Prats-Sánchez, Luis
A1 Marín, Rebeca
A1 Delgado-Mederos, Raquel
A1 Martínez-Domeño, Alejandro
A1 Camps-Renom, Pol
A1 Jiménez-Xarrié, Elena
A1 Zedde, Mariluisa
A1 Gómez-Choco, Manuel
A1 Lara, Lidia
A1 Boix, Amèlia
A1 Calleja, Ana
A1 De Arce-Borda, Ana María
A1 Bravo, Yolanda
A1 Fuentes, Blanca
A1 Hernández-Pérez, María
A1 Cánovas, David
A1 Llull, Laura
A1 Zandio, Beatriz
A1 Freijo, Marimar
A1 Casado-Naranjo, Ignacio
A1 Sanahuja, Jordi
A1 Cocho, Dolores
A1 Krupinski, Jerzy
A1 Rodríguez-Campello, Ana
A1 Palomeras, Ernest
A1 De Felipe, Alicia
A1 Serrano, Marta
A1 Zapata-Arriaza, Elena
A1 Zaragoza-Brunet, Josep
A1 Díaz-Maroto, Inmaculada
A1 Fernández-Domínguez, Jessica
A1 Lago, Aida
A1 Maestre, José
A1 Rodríguez-Yáñez, Manuel
A1 Gich, Ignasi
A1 HERO study investigators, 
AB We tested the hypothesis that the risk of intracranial hemorrhage (ICH) in patients with cardioembolic ischemic stroke who are treated with oral anticoagulants (OAs) can be predicted by evaluating surrogate markers of hemorrhagic-prone cerebral angiopathies using a baseline MRI. Patients were participants in a multicenter and prospective observational study. They were older than 64 years, had a recent cardioembolic ischemic stroke, and were new users of OAs. They underwent a baseline MRI analysis to evaluate microbleeds, white matter hyperintensities, and cortical superficial siderosis. We collected demographic variables, clinical characteristics, risk scores, and therapeutic data. The primary endpoint was ICH that occurred during follow-up. We performed bivariate and multivariate Cox regression analyses. We recruited 937 patients (aged 77.6 ± 6.5 years; 47.9% were men). Microbleeds were detected in 207 patients (22.5%), moderate/severe white matter hyperintensities in 419 (45.1%), and superficial siderosis in 28 patients (3%). After a mean follow-up of 23.1 ± 6.8 months, 18 patients (1.9%) experienced an ICH. In multivariable analysis, microbleeds (hazard ratio 2.7, 95% confidence interval [CI] 1.1-7, p = 0.034) and moderate/severe white matter hyperintensities (hazard ratio 5.7, 95% CI 1.6-20, p = 0.006) were associated with ICH (C index 0.76, 95% CI 0.66-0.85). Rate of ICH was highest in patients with both microbleed and moderate/severe WMH (3.76 per 100 patient-years, 95% CI 1.62-7.4). Patients taking OAs who have advanced cerebral small vessel disease, evidenced by microbleeds and moderate to severe white matter hyperintensities, had an increased risk of ICH. Our results should help to determine the risk of prescribing OA for a patient with cardioembolic stroke. NCT02238470.
YR 2019
FD 2019-04-19
LK http://hdl.handle.net/10668/13853
UL http://hdl.handle.net/10668/13853
LA en
DS RISalud
RD Apr 7, 2025