Risk of Intracerebral Haemorrhage in Chinese Patients Taking Oral Anticoagulants for Atrial Fibrillation with Cerebral Microbleeds. A Prospective Study in Warfarin. The IPAAC Warfarin Study
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AbstractBackground: Fear of devastating intracerebral haemorrhage (ICH) is the main factor limiting use of anticoagulants in atrial fibrillation (AF). MRI detection of CMBs, which predicts future ICH, may help guide anticoagulant decisions and improve stroke prevention. We aim to evaluate the risk of warfarinrelated ICH in Chinese AF patients with CMBs, who have higher risk of ICH than Caucasians.
Methods: In this prospective multicentre study, we recruited 237 Chinese AF patients anticoagulated with warfarin for evaluation of CMBs with 3T MRI brain. Primary outcome was clinical ICH at 2 years. Secondary outcomes were recurrent ischaemic stroke, systemic embolism, mortality of all causes and modified Rankin Scale.
Results: CMBs were observed in 84 (35.4%). Compared with patients without CMBs, patients with CMBs had a trend towards higher rate of ICH (3.6% vs 0.7%, p=0.095) and systemic embolism (2.4 vs 0%, p=0.055) at follow-up. While patients with ≥ 5 CMBs had significantly higher risk of ICH compared to those with <5 CMBs (27.3%vs 0.4%, p<0.001). After adjustment for age, ischaemic heart disease and prior use of anti-platelet agents, ≥ 5 CMBs (OR 55.08, 95% CI 2.22to 1369.45) and percentage of time with INR of ≥ 3 (OR 1.068, 95% CI 1.00 to 1.14) were independent predictors for ICH at 2 years.
Conclusions: Risk of warfarin-related ICH was significantly higher in Chinese patients with ≥ 5 CMBs. Close monitoring of INR or alternative stroke prevention strategies with better safety profile should be considered in these patients.
All Author(s) ListSoo Y, Leung KT, Abrigo J, Tsang SF, Fong WC, Li SH, Richard L, Ng PW, Fok J, Kiu WK, Ip V, Fan F, Au L, Chan A, Leung H, Ma SH, Mok V, Wong L, Chu W, Leung T
Journal nameInternational Journal of Stroke
Volume Number13
Issue NumberSuppl 2
Pages84 - 84
LanguagesEnglish-United Kingdom
Web of Science Subject CategoriesClinical Neurology;Peripheral Vascular Disease;Neurosciences & Neurology;Cardiovascular System & Cardiology

Last updated on 2021-19-09 at 00:46