Martí-Fàbregas, Joan;
Camps-Renom, Pol;
Best, Jonathan G;
Ramos-Pachon, Anna;
Guasch-Jiménez, Marina;
Martinez-Domeño, Alejandro;
Guisado-Alonso, Daniel;
... and Microbleeds International Collaborative Network (MICON); + view all
(2023)
Stroke Risk and Antithrombotic Treatment During Follow-up of Patients With Ischemic Stroke and Cortical Superficial Siderosis.
Neurology
, 100
(12)
e1267-e1281.
10.1212/WNL.0000000000201723.
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Abstract
BACKGROUND AND OBJECTIVES: In patients with ischemic stroke (IS) or TIA and cortical superficial siderosis (cSS), there are few data regarding the risk of future cerebrovascular events and also about the benefits and safety of antithrombotic drugs for secondary prevention. We investigated the associations of cSS and stroke risk in patients with recent IS or TIA. METHODS: We retrospectively analyzed the Microbleeds International Collaborative Network (MICON) database. We selected patients with IS or TIA from cohorts who had MRI-assessed cSS, available data on antithrombotic treatments, recurrent cerebrovascular events [Intracranial hemorrhage -ICrH-, IS, or any stroke (ICrH or IS)], and mortality. We calculated incidence rates (IR) and performed univariable and multivariable Cox regression analyses. RESULTS: Of 12.669 patients (mean age 70.4±12.3 years, 57.3% men), cSS was detected in 273 (2.2%) patients. During a mean follow-up of 24±17 months, IS was more frequent than ICrH in both cSS (IR 57.1 versus 14.6 per 1000 patient-years) and non-cSS groups (33.7 versus 6.3 per 1000 patient years). Compared to the non-CSS group, cSS was associated with any stroke on multivariable analysis [IR 83 versus 42 per 1000 patient-years, adjusted HR for cSS 1.62 (95%CI: 1.14-2.28; p=0.006)]. This association was not significant in subgroups of patients treated with antiplatelet drugs (n=6.554) or with anticoagulants (n=4.044). Patients with cSS who were treated with both antiplatelet drugs and anticoagulants (n=1.569) had a higher incidence of ICrH (IR 107.5 vs 4.9 per 1000 patient-years, adjusted HR 13.26; 95%CI: 2.90-60.63; p=0.001) and of any stroke (IR 198.8 vs 34.7 per 1000 patient-years, adjusted HR 5.03; 95%CI: 2.03-12.44; p<0.001) compared to the non-CSS group. DISCUSSION: Patients with IS or TIA with cSS are at increased risk of stroke (ICrH or IS) during follow-up; the risk of IS exceeds that of ICrH for patients receiving antiplatelet or anticoagulant treatment alone, but the risk of ICrH exceeds that of IS in patients receiving both treatments. The findings suggest that either antiplatelet or anticoagulant treatment alone should not be avoided in patients with cSS, but combined antithrombotic therapy might be hazardous. Our findings need to be confirmed by randomized clinical trials.
| Type: | Article |
|---|---|
| Title: | Stroke Risk and Antithrombotic Treatment During Follow-up of Patients With Ischemic Stroke and Cortical Superficial Siderosis |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1212/WNL.0000000000201723 |
| Publisher version: | https://doi.org/10.1212/WNL.0000000000201723 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Cerebrovascular Disease/Stroke, Cohort studies, Epidemiology, Intracerebral hemorrhage, Stroke prevention, Subarachnoid hemorrhage |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Brain Repair and Rehabilitation |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10164577 |
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