Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA.
Stroke. 2024 Nov;55(11):2677-2684. doi: 10.1161/STROKEAHA.124.048243. Epub 2024 Oct 2.
It is unknown whether hypertensive microangiopathy or cerebral amyloid angiopathy (CAA) predisposes more to anticoagulant-associated intracerebral hemorrhage (AA-ICH). The purpose of our study was to determine whether AA-ICH is associated with lobar location and probable CAA.
This was a cross-sectional analysis of patients with first-ever spontaneous ICH admitted to a tertiary hospital in Boston, between 2008 and 2023. Univariable and multivariable logistic regression were used to investigate the association between anticoagulation use and both lobar hemorrhage location and probable CAA on magnetic resonance imaging (MRI) by Boston Criteria 2.0 or computed tomography by Simplified Edinburgh Criteria.
A total of 1104 patients (mean [SD] age, 73 [12]; 499 females [45.0%]) were included. Of the 1104 patients, 268 (24.3%) had AA-ICH: 148 (55.2%) with vitamin K antagonists and 107 (39.9%) with direct oral anticoagulants. Brain MRI was performed in 695 (63.0%) patients. The proportion of patients with lobar hemorrhage was not different between those with and without AA-ICH (121/268 [45.1%] versus 424/836 [50.7%]; odds ratio [OR], 0.80 [95% CI, 0.61-1.05]; =0.113). Patients with AA-ICH were less likely to have probable CAA on MRI (17/146 [11.6%] versus 127/549 [23.1%]; OR, 0.44 [95% CI, 0.25-0.75]; =0.002) and probable CAA on MRI or computed tomography if MRI not performed (27/268 [10.0%] versus 200/836 [23.9%]; OR, 0.36 [95% CI, 0.23-0.55]; <0.001). Among patients with AA-ICH, there were no differences in the proportion with lobar hemorrhage (63/148 [42.6%] versus 46/107 [43.0%]; OR, 1.02 [95% CI, 0.62-1.68]; =0.946) or probable CAA on MRI (10/72 [13.9%] versus 7/69 [10.1%]; OR, 0.70 [95% CI, 0.25-1.96]; =0.495) between vitamin K antagonists and direct oral anticoagulant users.
AA-ICH was not associated with lobar hemorrhage location but was associated with reduced odds of probable CAA. These results suggest that hypertensive microangiopathy may predispose more toward incident AA-ICH than CAA and emphasize the importance of blood pressure control among anticoagulant users. These findings require replication in additional cohorts.
目前尚不清楚高血压性微血管病还是脑淀粉样血管病（CAA）更容易导致抗凝相关脑出血（AA-ICH）。我们的研究目的是确定 AA-ICH 是否与脑叶部位和可能的 CAA 有关。
这是一项对 2008 年至 2023 年期间在波士顿一家三级医院首次自发性脑出血患者的横断面分析。使用单变量和多变量逻辑回归分析抗凝治疗与波士顿 2.0 磁共振成像（MRI）或简化爱丁堡标准计算机断层扫描（CT）上的脑叶出血部位和可能的 CAA 之间的关系。
共纳入 1104 例患者（平均[标准差]年龄 73[12]岁；499 例女性[45.0%]）。在 1104 例患者中，268 例（24.3%）发生 AA-ICH：148 例（55.2%）使用维生素 K 拮抗剂，107 例（39.9%）使用直接口服抗凝剂。对 695 例（63.0%）患者进行了脑 MRI 检查。有和无 AA-ICH 患者的脑叶出血比例无差异（268 例中有 121 例[45.1%]，836 例中有 424 例[50.7%]；比值比[OR]，0.80[95%CI，0.61-1.05]；=0.113）。AA-ICH 患者的 MRI 上可能 CAA 比例较低（146 例中有 17 例[11.6%]，549 例中有 127 例[23.1%]；OR，0.44[95%CI，0.25-0.75]；=0.002），如果未进行 MRI 检查，则 MRI 或 CT 上可能 CAA 的比例也较低（268 例中有 27 例[10.0%]，836 例中有 200 例[23.9%]；OR，0.36[95%CI，0.23-0.55]；<0.001）。在 AA-ICH 患者中，脑叶出血比例（148 例中有 63 例[42.6%]，107 例中有 46 例[43.0%]；OR，1.02[95%CI，0.62-1.68]；=0.946）或 MRI 上可能 CAA（72 例中有 10 例[13.9%]，69 例中有 7 例[10.1%]；OR，0.70[95%CI，0.25-1.96]；=0.495）在维生素 K 拮抗剂和直接口服抗凝剂使用者之间均无差异。
AA-ICH 与脑叶出血部位无关，但与可能的 CAA 发生几率降低有关。这些结果表明，高血压性微血管病可能比 CAA 更易导致 AA-ICH 事件发生，强调了抗凝治疗患者控制血压的重要性。这些发现需要在其他队列中进行复制。
