Akoudad Saloua, Darweesh Sirwan K L, Leening Maarten J G, Koudstaal Peter J, Hofman Albert, van der Lugt Aad, Stricker Bruno H, Ikram M Arfan, Vernooij Meike W
From the Departments of Epidemiology (S.A., S.K.L.D., M.J.G.L., A.H., B.H.S., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), and Cardiology (M.J.G.L.), Erasmus MC, Rotterdam, the Netherlands; and Inspectorate of Health Care, The Hague, the Netherlands (B.H.S.).
Stroke. 2014 Nov;45(11):3436-9. doi: 10.1161/STROKEAHA.114.007112. Epub 2014 Oct 14.
It remains undetermined whether the use of coumarin anticoagulants associates with cerebral microbleeds in the general population. We investigated whether (1) coumarin use relates to higher prevalence and incidence of microbleeds, (2) microbleeds are more frequent in people with higher maximum international normalized ratios (INRs), and (3) among coumarin users, variability in INR associates with microbleed presence.
From the population-based Rotterdam Study, 4945 participants aged ≥45 years were included in the cross-sectional analysis, and 3069 participants had follow-up brain MRI. Information on coumarin use was obtained from automated pharmacy records. Coumarin users were monitored, and INR values were measured in consecutive visits. Presence and location of microbleeds were rated on brain MRI. We investigated the association of coumarin use with microbleeds using multivariable logistic regression.
Overall, 8.6% had used coumarin anticoagulants before the first MRI and 5.9% before follow-up MRI. The prevalence of microbleeds was 19.4%, and the incidence was 6.9% during a mean follow-up of 3.9 years (SD, 0.5). Compared with never users, coumarin users had a higher prevalence of deep or infratentorial microbleeds and a higher incidence of any microbleeds, although statistical significance was not reached in the latter. A higher maximum INR was associated with deep or infratentorial microbleeds. Among coumarin users, a greater variability in INR was associated with a higher prevalence of microbleeds.
Coumarin use is associated with microbleeds. Associations were strongest for people with greater variability in INR.
在普通人群中，香豆素类抗凝剂的使用是否与脑微出血相关尚不确定。我们调查了以下问题：（1）使用香豆素是否与微出血的更高患病率和发病率相关；（2）在国际标准化比值（INR）最高的人群中微出血是否更常见；（3）在香豆素使用者中，INR的变异性是否与微出血的存在相关。
基于鹿特丹研究，4945名年龄≥45岁的参与者纳入横断面分析，3069名参与者接受了脑部MRI随访。香豆素使用信息从自动药房记录中获取。对香豆素使用者进行监测，并在连续就诊时测量INR值。在脑部MRI上对微出血的存在和位置进行评分。我们使用多变量逻辑回归研究香豆素使用与微出血之间的关联。
总体而言，8.6%的人在首次MRI检查前使用过香豆素类抗凝剂，5.9%的人在随访MRI检查前使用过。微出血的患病率为19.4%，在平均3.9年（标准差，0.5）的随访期间发病率为6.9%。与从未使用者相比，香豆素使用者深部或幕下微出血的患病率更高，任何微出血的发病率也更高，尽管后者未达到统计学显著性。最高INR较高与深部或幕下微出血相关。在香豆素使用者中，INR的变异性越大与微出血的患病率越高相关。
使用香豆素与微出血相关。对于INR变异性较大的人，这种关联最为明显。
