Šrámková Tereza, Vaňásek Tomáš, Šrámek Martin, Janský Petr, Benešová Kateřina, Olšerová Anna, Kmetonyová Silvia, Paulasová-Schwabová Jaroslava, Klíma Michal, Michal Lukáš, Kala David, Otáhal Jakub, Mikšík Lukáš, Tomek Aleš
Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital Motol, Prague, Czech Republic.
Department of Radiology, Second Faculty of Medicine, Charles University and Motol University Hospital Motol, Prague, Czech Republic.
Medicine (Baltimore). 2025 May 23;104(21):e42011. doi: 10.1097/MD.0000000000042011.
Patients with cardioembolic ischemic stroke are commonly prescribed direct oral anticoagulants (DOACs), such as dabigatran (a direct thrombin inhibitor) and factor Xa inhibitors (e.g., apixaban and rivaroxaban), or warfarin to reduce the risk of recurrent stroke. A major concern in anticoagulant therapy is the risk of intracerebral hemorrhage, which is associated with a high mortality rate. Cerebral microbleeds (MBs), small asymptomatic brain hemorrhages detectable by susceptibility-weighted imaging (SWI) on magnetic resonance imaging (MRI), are associated with increased hemorrhagic stroke risk. This study evaluated the incidence of new MBs during 1 year of anticoagulation therapy in patients after cardioembolic stroke. Patients indicated for anticoagulant therapy after cardioembolic stroke and monitored in the cerebrovascular outpatient clinic of our department underwent brain MRI at baseline and after 1 year of therapy. The occurrence of new MBs was assessed using SWI sequences. MBs were categorized based on location into 3 groups: deep (dMBs), lobar (lMBs), and infratentorial (iMBs). A total of 79 patients were included, 53 of whom were male (67.1%), with a median age of 71 years (IQR: 64-76). The majority of patients (n = 50, 63.3%) were treated with apixaban, 16 patients (20.3%) with dabigatran, and 13 patients (16.5%) with warfarin. Baseline MRI revealed MBs in 17 patients (21.5%), including dMBs in 2, lMBs in 16, and iMBs in 2 patients. Follow-up MRI showed new MBs in 8 patients (10.1%), with new dMBs in 1, lMBs in 5, and iMBs in 4 patients. No statistically significant differences were observed in MBs the incidence of new MBs between anticoagulant groups (P = .912). Over 1 year of anticoagulant therapy, new MBs were detected in 10.1% of patients, predominantly in lobar and infratentorial regions. No differences in the incidence of new MBs were identified between the different anticoagulant groups.
心源性栓塞性缺血性中风患者通常会被处方直接口服抗凝剂（DOACs），如达比加群（一种直接凝血酶抑制剂）和Xa因子抑制剂（如阿哌沙班和利伐沙班），或华法林，以降低复发性中风的风险。抗凝治疗中的一个主要问题是脑出血风险，这与高死亡率相关。脑微出血（MBs）是磁共振成像（MRI）上通过磁敏感加权成像（SWI）可检测到的无症状小脑出血，与出血性中风风险增加相关。本研究评估了心源性栓塞性中风患者抗凝治疗1年内新出现脑微出血的发生率。在心源性栓塞性中风后接受抗凝治疗并在我院脑血管门诊接受监测的患者在基线时和治疗1年后进行了脑部MRI检查。使用SWI序列评估新脑微出血的发生情况。脑微出血根据位置分为3组：深部（dMBs）、叶部（lMBs）和幕下（iMBs）。共纳入79例患者，其中53例为男性（67.1%），中位年龄为71岁（四分位间距：64 - 76岁）。大多数患者（n = 50，63.3%）接受阿哌沙班治疗，16例患者（20.3%）接受达比加群治疗，13例患者（16.5%）接受华法林治疗。基线MRI显示17例患者（21.5%）存在脑微出血，其中2例为深部脑微出血，16例为叶部脑微出血，2例为幕下脑微出血。随访MRI显示8例患者（10.1%）出现新的脑微出血，其中1例为新的深部脑微出血，5例为叶部脑微出血，4例为幕下脑微出血。抗凝组之间新脑微出血的发生率未观察到统计学显著差异（P = 0.912）。在1年的抗凝治疗期间，10.1%的患者检测到新的脑微出血，主要发生在叶部和幕下区域。不同抗凝组之间新脑微出血的发生率未发现差异。
