Clinical and neuroimaging risk factors associated with the development of intracerebral hemorrhage while taking direct oral anticoagulants.
Clinical and neuroimaging risk factors associated with the development of intracerebral hemorrhage while taking direct oral anticoagulants.
复制标题
直接服用口服抗凝剂时与脑出血发生相关的临床和神经影像学危险因素。
DOI：
10.1007/s00415-022-11333-2
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发表时间：
2022
影响因子：
6
通讯作者：
Gurol,MEdip
中科院分区：
文献类型：
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作者：
Das,AlvinS;Gökçal,Elif;Regenhardt,RobertW;Warren,AndrewD;Biffi,Alessandro;Goldstein,JoshuaN;Kimberly,WTaylor;Viswanathan,Anand;Schwamm,LeeH;Rosand,Jonathan;Greenberg,StevenM;Gurol,MEdip
背景和目的与直接口服抗凝剂（DOAC）使用相关的脑出血（ICH）导致显著的死亡率/残疾率。我们的目的是了解临床和神经影像学特征与发展ICH之间DOAC users.MethodsClinical和放射学数据收集连续DOAC用户ICH（DOAC-ICH）和年龄匹配的对照组，没有ICH从一个单一的转诊中心。评估了出血风险MRI标记物的频率/分布。在单变量检验中比较基线人口统计学和神经影像学标志物。结果86例DOAC-ICH患者和94例无ICH患者均符合ICH诊断标准。糖尿病、冠状动脉疾病、既往缺血性卒中、吸烟史和抗血小板药物使用在ICH患者中比无ICH DOAC使用者更常见。在神经影像学分析中，重度白色高信号（WMH）、腔隙、皮质浅表铁质沉着症（cSS）和脑微出血（CMB）在ICH队列中比无ICH队列更常见。在多因素回归分析中，糖尿病[OR3.5395%CI（1.05-11.87）]，既往缺血性卒中[OR 14.80 95% CI（3.33-65.77）]、吸烟史[OR 3.08 95%CI（1.05-9.01）]，CMBs [OR 4.07 95%CI（1.45-11.39）]和cSS [OR 39.73 95% CI（3.43-460.24）]与ICH独立相关。吸烟史以及MRI生物标志物包括CMB和cSS与DOAC使用者的ICH相关。尽管在开始DOAC治疗之前通常不进行MRI筛查，但这些数据表明可以识别出高出血风险的患者。
Background and aimsIntracerebral hemorrhage (ICH) associated with direct oral anticoagulant (DOAC) usage confers significant mortality/disability. We aimed to understand the clinical and neuroimaging features associated with developing ICH among DOAC users.MethodsClinical and radiological data were collected from consecutive DOAC users with ICH (DOAC-ICH) and age-matched controls without ICH from a single referral center. The frequency/distribution of MRI markers of hemorrhage risk were assessed. Baseline demographics and neuroimaging markers were compared in univariate tests. Significant associations (p< 0.1) were entered into a multivariable regression model to determine predictors of ICH.Results86 DOAC-ICH and 94 ICH-free patients were included. Diabetes, coronary artery disease, prior ischemic stroke, smoking history, and antiplatelet usage were more common in ICH patients than ICH-free DOAC users. In the neuroimaging analyses, severe white matter hyperintensities (WMHs), lacunes, cortical superficial siderosis (cSS), and cerebral microbleeds (CMBs) were more common in the ICH cohort than the ICH-free cohort. In the multivariable regression, diabetes [OR 3.53 95% CI (1.05–11.87)], prior ischemic stroke [OR 14.80 95% CI (3.33–65.77)], smoking history [OR 3.08 95% CI (1.05–9.01)], CMBs [OR 4.07 95% CI (1.45–11.39)], and cSS [OR 39.73 95% CI (3.43–460.24)] were independently associated with ICH.ConclusionsRisk factors including diabetes, prior stroke, and smoking history as well as MRI biomarkers including CMBs and cSS are associated with ICH in DOAC users. Although screening MRIs are not typically performed prior to initiating DOAC therapy, these data suggest that patients of high-hemorrhagic risk may be identified.