Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain.
Department of Radiology, Hospital del Mar- Parc de Salut Mar, Barcelona, Spain.
Sci Rep. 2018 Jan 24;8(1):1492. doi: 10.1038/s41598-018-20055-3.
We investigated whether pre-treatment with statins is associated with surrogate markers of amyloid and hypertensive angiopathies in patients who need to start long-term oral anticoagulation therapy. A prospective multicenter study of patients naive for oral anticoagulants, who had an acute cardioembolic stroke. MRI was performed at admission to evaluate microbleeds, leukoaraiosis and superficial siderosis. We collected data on the specific statin compound, the dose and the statin intensity. We performed bivariate analyses and a logistic regression to investigate variables associated with microbleeds. We studied 470 patients (age 77.5 ± 6.4 years, 43.7% were men), and 193 (41.1%) of them received prior treatment with a statin. Microbleeds were detected in 140 (29.8%), leukoaraiosis in 388 (82.5%) and superficial siderosis in 20 (4.3%) patients. The presence of microbleeds, leukoaraiosis or superficial siderosis was not related to pre-treatment with statins. Microbleeds were more frequent in patients with prior intracerebral hemorrhage (OR 9.7, 95% CI 1.06-90.9) and in those pre-treated antiplatelets (OR 1.66, 95% CI 1.09-2.53). Prior treatment with statins was not associated with markers of bleeding-prone cerebral angiopathies in patients with cardioembolic stroke. Therefore, previous statin treatment should not influence the decision to initiate or withhold oral anticoagulation if these neuroimaging markers are detected.
我们研究了在需要开始长期口服抗凝治疗的患者中,他汀类药物预处理是否与淀粉样蛋白和高血压性血管病变的替代标志物相关。这是一项针对初发口服抗凝剂患者的前瞻性多中心研究,这些患者患有急性心源性脑栓塞。入院时进行 MRI 以评估微出血、脑白质疏松症和脑表铁沉积症。我们收集了特定他汀类化合物、剂量和他汀类药物强度的数据。我们进行了双变量分析和逻辑回归分析,以调查与微出血相关的变量。我们研究了 470 名患者(年龄 77.5±6.4 岁,43.7%为男性),其中 193 名(41.1%)患者之前接受过他汀类药物治疗。140 名(29.8%)患者检测到微出血,388 名(82.5%)患者检测到脑白质疏松症,20 名(4.3%)患者检测到脑表铁沉积症。微出血、脑白质疏松症或脑表铁沉积症的存在与他汀类药物预处理无关。先前有颅内出血的患者(OR 9.7,95%CI 1.06-90.9)和先前接受抗血小板治疗的患者(OR 1.66,95%CI 1.09-2.53)中微出血更为常见。在患有心源性脑栓塞的患者中,他汀类药物预处理与易出血性脑血管病变的标志物无关。因此,如果这些神经影像学标志物被检测到,先前的他汀类药物治疗不应影响开始或停止口服抗凝的决定。