Mutsumi Yokoyama1, Atsushi Mizuma2, Tohru Terao3, Fumiaki Tanaka4, Kazutoshi Nishiyama5, Yasuhiro Hasegawa6, Eiichiro Nagata2, Shigeru Nogawa7, Hiroyuki Kobayashi8, Noriharu Yanagimachi9, Takashi Okazaki9, Kazuo Kitagawa10, Shunya Takizawa11. 1. Department of Neurology, Fujisawa City Hospital, Fujiswa, Kanagawa, Japan. 2. Departments of Neurology, Tokai University School of Medicine, Isehara, Tokyo, Japan. 3. Department of Neurosurgery, Atsugi City Hospital, Atsugi, Kanagawa, Japan. 4. Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan. 5. Department of Neurology, Kitasato University School of Medicine, Tokyo, Japan. 6. Department of Neurology, St. Marianna University School of Medicine, Kwasaki, Kanagawa, Japan. 7. Department of Neurology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan. 8. Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Tokyo, Japan. 9. Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Tokyo, Japan. 10. Department of Neurology, Tokyo Women's Medical University, Shinjuku City, Tokyo, Japan. 11. Departments of Neurology, Tokai University School of Medicine, Isehara, Tokyo, Japan. Electronic address: shun@is.icc.u-tokai.ac.jp.
Abstract
BACKGROUND: Nonvitamin K antagonist oral anticoagulants (NOACs) are considered superior, or at least noninferior, to warfarin in preventing stroke or systemic embolism in patients with nonvalvular atrial fibrillation. Here, we recruited acute ischemic stroke patients with nonvalvular atrial fibrillation and at least one cerebral microbleed (CMB), and evaluated the proportion of patients who had an increased number of CMBs (%) after receiving anticoagulant therapy with NOACs or with warfarin for 12 months. METHODS: This was a multicenter, prospective, observational cohort study at 20 centers, conducted between 2015 and 2017, in which we recruited 85 patients with at least one CMB detected by 1.5T magnetic resonance imaging (T2*WI) at baseline, who received NOACs or warfarin for at least 12 months. We compared the proportions of patients with increased numbers of CMBs in the NOACs and warfarin treatment groups. RESULTS: The proportions of patients with increased numbers of CMBs at month 12 of treatment were 28.6% and 66.7% in the NOACs and warfarin groups, respectively. The new CMBs showed no specific regional localization in either group. In the NOACs and warfarin groups, physicians prescribed lower-than-standard dosing in 13.3% and 50% of the cases, respectively. The administration of reduced doses at physicians' discretion did not appear to alter the incidence of new CMBs. DISCUSSION: This is the first evidence to suggest efficacy of NOACs for preventing further CMBs in patients with at least one CMB, although no statistical evaluation was carried out.
BACKGROUND:Nonvitamin K antagonist oral anticoagulants (NOACs) are considered superior, or at least noninferior, to warfarin in preventing stroke or systemic embolism in patients with nonvalvular atrial fibrillation. Here, we recruited acute ischemic strokepatients with nonvalvular atrial fibrillation and at least one cerebral microbleed (CMB), and evaluated the proportion of patients who had an increased number of CMBs (%) after receiving anticoagulant therapy with NOACs or with warfarin for 12 months. METHODS: This was a multicenter, prospective, observational cohort study at 20 centers, conducted between 2015 and 2017, in which we recruited 85 patients with at least one CMB detected by 1.5T magnetic resonance imaging (T2*WI) at baseline, who received NOACs or warfarin for at least 12 months. We compared the proportions of patients with increased numbers of CMBs in the NOACs and warfarin treatment groups. RESULTS: The proportions of patients with increased numbers of CMBs at month 12 of treatment were 28.6% and 66.7% in the NOACs and warfarin groups, respectively. The new CMBs showed no specific regional localization in either group. In the NOACs and warfarin groups, physicians prescribed lower-than-standard dosing in 13.3% and 50% of the cases, respectively. The administration of reduced doses at physicians' discretion did not appear to alter the incidence of new CMBs. DISCUSSION: This is the first evidence to suggest efficacy of NOACs for preventing further CMBs in patients with at least one CMB, although no statistical evaluation was carried out.
Authors: Benjamin Wagner; Lisa Hert; Alexandros A Polymeris; Sabine Schaedelin; Johanna M Lieb; David J Seiffge; Christopher Traenka; Sebastian Thilemann; Joachim Fladt; Valerian L Altersberger; Annaelle Zietz; Tolga D Dittrich; Urs Fisch; Henrik Gensicke; Gian Marco De Marchis; Leo H Bonati; Philippe A Lyrer; Stefan T Engelter; Nils Peters Journal: Front Neurol Date: 2022-09-20 Impact factor: 4.086