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Leukoaraiosis is an independent predictor of intracranial hemorrhage in patients with atrial fibrillation

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Abstract

We evaluated the predictive value of several clinical, radiological and laboratory parameters on the risk of predict intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF). We conducted a case-control study on a consecutive hospital based series of patients with AF and ICH. A random sample of subjects with AF without ischemic or hemorrhagic stroke was selected from the same hospital in the same period to perform as the control group, with a ratio of two controls per case. All patients underwent the same evaluation protocol. Patients without neuroimaging exams were excluded. During the study period we identified 37 subjects with AF and ICH. 74 subjects without stroke events were randomly chosen among subjects with AF. Among cases 56.8% were female; mean age was 83.1 years. Patients with ICH were more often on anticoagulant therapy (75.7%), compared with controls (45.9%; p = 0.0002). On CT scans, cases had a greater severity of leukoaraiosis at the Blennow scale (p < 0.0001) and a higher frequency of lacunar infarcts (p = 0.006). No significant association was found between MRI parameters or the HAS-BLED score and the occurrence of ICH. CT scan is more useful than MRI and HAS-BLED score to predict ICH in patients with AF on antithrombotic therapy.

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References

  1. Albers GW (1994) Atrial fibrillation and stroke. Three new studies, three remaining questions. Arch Intern Med 154:1443–1448

    Article  CAS  PubMed  Google Scholar 

  2. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ (2001) Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 285(22):2864–2870

    Article  CAS  Google Scholar 

  3. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GY, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K (2016) 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 18(11):1609–1678

    Article  Google Scholar 

  4. Abu-Assi E, Otero-Raviña F, Allut Vidal G, Coutado Méndez A, Vaamonde Mosquera L, Sánchez Loureiro M, Caneda Villar MC, Fernández Villaverde JM, Maestro Saavedra FJ, González-Juanatey JR; Grupo Barbanza researchers (2013) Comparison of the reliability and validity of four contemporary risk stratification schemes to predict thromboembolism in non-anticoagulated patients with atrial fibrillation. Int J Cardiol 166(1):205–209

    Article  CAS  PubMed  Google Scholar 

  5. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY (2010) A novel user-friendly score (HAS-BLED) to assess one-year risk of major bleeding in atrial fibrillation patients: the Euro Heart Survey. Chest 138:1093–1100

    Article  PubMed  Google Scholar 

  6. Fang MC, Chang Y, Hylek EM, Rosand J, Greenberg SM, Go AS, Singer DE (2004) Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. Ann Intern Med 141:745–752

    Article  PubMed  Google Scholar 

  7. Palareti G, Leali N, Coccheri S, Poggi M, Manotti C, D’Angelo A, Pengo V, Erba N, Moia M, Ciavarella N, Devoto G, Berrettini M, Musolesi S (1996) Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Italian Study on Complications of Oral Anticoagulant Therapy. Lancet 348:423–428

    Article  CAS  Google Scholar 

  8. Hylek EM, Singer DE (1994) Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med 120:897–902

    Article  CAS  PubMed  Google Scholar 

  9. Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF (2001) Spontaneous intracerebral hemorrhage. N Engl J Med 344(19):1450–1460

    Article  CAS  PubMed  Google Scholar 

  10. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, ESC Scientific Document Group (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18(8):891–975

    Article  Google Scholar 

  11. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24(1):35–41

    Article  Google Scholar 

  12. Blennow K, Wallin A, Uhlemann C, Gottfries GC (1991) White matter lesions on CT in Alzheimer patients: relation to clinical symptomatology and vascular factors. Acta Neurol Scand 83:187–193

    Article  CAS  PubMed  Google Scholar 

  13. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA (1987) MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJNR Am J Neuroradiol 8:421–426

    Google Scholar 

  14. Bungard TJ, Ghali WA, Teo KK, McAlister FA, Tsuyuki RT (2000) Why do patients with atrial fibrillation not receive warfarin? Arch Intern Med 160(1):41–46

    Article  CAS  PubMed  Google Scholar 

  15. Gorter JW (1999) Major bleeding during anticoagulation after cerebral ischemia: patterns and risk factors. Stroke Prevention In Reversible Ischemia Trial (SPIRIT). European Atrial Fibrillation Trial (EAFT) study groups. Neurology 53(6):1319–1327

    Article  CAS  PubMed  Google Scholar 

  16. Kase CS, Robinson RK, Stein RW, DeWitt LD, Hier DB, Harp DL, Williams JP, Caplan LR, Mohr JP (1985) Anticoagulant-related intracerebral hemorrhage. Neurology 35:943–948

    Article  CAS  PubMed  Google Scholar 

  17. Radberg JA, Olsson JE, Radberg CT (1991) Prognostic parameters in spontaneous intracerebral hematomas with special reference to anticoagulant treatment. Stroke 22:571–576

    Article  CAS  PubMed  Google Scholar 

  18. O’Donnell HC, Rosand J, Knudsen KA, Furie KL, Segal AZ, Chiu RI, Ikeda D, Greenberg SM (2000) Apolipoprotein E genotype and the risk of recurrent lobar intracerebral hemorrhage. N Engl J Med 342:240–245

    Article  PubMed  Google Scholar 

  19. Smith EE, Rosand J, Knudsen KA, Hylek EM, Greenberg SM (2002) Leukoaraiosis is associated with warfarin-related hemorrhage following ischemic stroke. Neurology 59(2):193–197

    Article  CAS  PubMed  Google Scholar 

  20. Tanaka A, Ueno Y, Nakayama Y, Takano K, Takebayashi S (1999) Small chronic hemorrhages and ischemic lesions in association with spontaneous intracerebral hematomas. Stroke 30(8):1637–1642

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Life, Health & Environmental Sciences, University of L’Aquila, Piazzale S. Tommasi, Coppito- L’Aquila, Italy

    F. Crosta, G. Desideri & C. Marini

  2. Sbarro Institute for Cancer Research and Molecular Medicine, Temple University, Philadelphia, USA

    G. Desideri

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  1. F. Crosta
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  2. G. Desideri
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Correspondence to F. Crosta.

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Crosta, F., Desideri, G. & Marini, C. Leukoaraiosis is an independent predictor of intracranial hemorrhage in patients with atrial fibrillation. J Thromb Thrombolysis 47, 527–532 (2019). https://doi.org/10.1007/s11239-019-01839-4

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