Anticoagulants and risk of bleeding

MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation

For the HERO investigators, Drs. Martí-Fàbregas et al. report their results from the prospective, multicenter observational cohort that sought to estimate the long-term risk of intracranial hemorrhage (ICH) among patients aged >65 years with cardioembolic stroke and treated with an oral anticoagulant. Nearly 1,000 patients were followed over mean of 2 years. Ninety percent of patients had atrial fibrillation as the primary indication for anticoagulation, and two-thirds of patients were treated using warfarin. The annualized rate of ICH was 1%/yr-as has been previously reported-with a higher rate among patients with cerebral microhemorrhages (2.5%/yr with >1 microhemorrhage), with moderate/severe microvascular changes on MRI (2%/yr), and with both of these findings (3.8%/yr).

Dr. Vilanilam and colleagues highlight a study limitation that included patients were not evaluated using identical MRI magnet strength (16% underwent 3T MRI) or MRI sequences (49% underwent SWI; 91% underwent GRE with or without SWI). The authors acknowledge that this could have affected their findings and stressed the uniformity of MRI magnet strength and consistency of sequences for future studies.

Published in Neurology May 05, 2020; 94 (18)