Relative Impact of Modifiable Risk Factors in Warfarin-associated Intracerebral Haemorrhage Among Chinese Atrial Fibrillation Patients with Cerebral Microbleeds
Invited conference paper presented and published in conference proceedings


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AbstractBackground Atrial fibrillation (AF) patients with cerebral microbleeds (CMBs) have increased risk of warfarin-associated intracerebral haemorrhage (ICH), which may be potentially reduced by stringent control of modifiable risk factors. This study aims to explore the relative impact of over-warfarinization and hypertensive arteriopathy to ICH in AF patients with CMBs.

Method We recruited Chinese AF patients on warfarin for 3T MRI brain. We examined the correlation of percentage of time with INR ≥3, deep and subcortical CMBs counts with clinical ICH during the 2-year follow-up.

Results Total 237 patients were included. CMBs were present in 84 (35.4%) patients. During the mean follow-up period of 22.4±10.3 months, 4 patients developed ICH (2 in basal ganglia, 1 in lobar region and 1 in cerebellum). In univariate logistic regression, presence of subcortical CMBs (OR 17.56, 95% CI 1.77-173.78), deep CMBs (OR 9.13, 95% CI 1.23-67.92) were more predictive of ICH than percentage of time with INR ≥3 (OR 1.05, 95% CI 1.01-1.10). In ROC analysis, subcortical CMB counts was most sensitive in predicting ICH (c-index 0.813), compared to cortical CMBs count (c-index 0.705), deep CMB count (c-index 0.722), infratentorial CMBs count (c-index 0.715) and percentage of time with INR ≥3 (c-index 0.538).

Conclusion In Chinese AF patients with CMBs, hypertensive arteriopathy has greater impact than over-warfarinization in modulating risk of ICH. Compared to frequent INR monitoring which has only marginal benefit in reducing risk of ICH, stringent control of blood pressure may be more effective in preventing this devastating adverse outcome.
All Author(s) ListYannie Soo, Jill Abrigo, Kam Tat Leung, Suk Fung Tsang, Hing Lung Ip, Sze Ho Ma, Karen Ma, Wing Chi Fong, Siu Hung Li, Richard Li, Ping Wing Ng, Kwok Kui Wong, Wenyan Liu, Bonnie Lam, Lawrence Wong, Vincent Mok, Winnie Chiu Wing Chu, Thomas Leung, on behalf of the IPAAC study group
Name of Conference5th European Stroke Organisation Conference (ESOC 2019)
Start Date of Conference22/05/2019
End Date of Conference24/05/2019
Place of ConferenceMilan
Country/Region of ConferenceItaly
Year2019
Month5
LanguagesEnglish-United Kingdom

Last updated on 2019-25-11 at 12:06