Age and coumarin-type anticoagulation are associated with the occurrence of intraplaque hemorrhage, while statins are associated less with intraplaque hemorrhage: A large histopathological study in carotid and femoral plaques

Derksen, Wouter J.M.; Peeters, Wouter; Tersteeg, Claudia; Vries, Jean‐Paul P.M. de; Kleijn, Dominique P.V. de; Moll, Frans L.; Wal, Allard C. van der; Pasterkamp, Gérard; Vink, Aryan

doi:10.1016/j.atherosclerosis.2010.10.022

Cited by 35 publications

(25 citation statements)

References 27 publications

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“…9 A histopathology study of 794 carotid endarterectomy patients (84% symptomatic) found a prevalence of IPH as high as 81% and found no association with antiplatelet therapy. 7 However, in that study, the reported rate of antiplatelet agent use was 93%. This percentage probably includes both patients who used antiplatelet therapy before the event that led to the endarterectomy and patients who only started therapy after the event, shortly before endarterectomy.…”

Section: December 2015mentioning

confidence: 66%

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Use of Antiplatelet Agents Is Associated With Intraplaque Hemorrhage on Carotid Magnetic Resonance Imaging

Liem

Schreuder

Dijk

et al. 2015

Stroke

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A therosclerosis in the carotid arteries is an important cause of ischemic stroke. Treatment decisions for carotid artery stenosis are currently based on the degree of luminal narrowing and the presence or absence of recent ipsilateral stroke or transient ischemic attack (TIA). However, there is increasing evidence that additional factors may be useful in stratifying a patient's risk of stroke recurrence. A potent strategy may be the identification of so-called vulnerable plaque features, that is, intraplaque hemorrhage (IPH), a large lipid-rich necrotic core and a thin or ruptured fibrous cap.1-4 Plaques with these characteristics are associated with an increased risk of plaque rupture and subsequent embolization. A key feature of vulnerable plaques is IPH, which can be studied in vivo with highresolution carotid plaque magnetic resonance imaging (MRI). In cohort studies, IPH has shown to be a predictor of ipsilateral stroke and TIA in patients with symptomatic and to a lesser extend with asymptomatic carotid stenosis. 3,5 Associations between clinical patient characteristics and vulnerable plaque characteristics have not been widely studied.6-9 It would be important to learn more about clinical determinants of IPH because it can give us information on the mechanism of vulnerable plaque development and Background and Purpose-Intraplaque hemorrhage (IPH), visualized by magnetic resonance imaging, has shown to be associated with the risk of stroke in patients with carotid artery stenosis. The mechanisms of IPH development are poorly understood. In this study, we investigated the association between clinical patient characteristics and carotid IPH on highresolution magnetic resonance imaging. Methods-Patients participate in the Plaque at Risk (PARISK) study. This prospective, multicenter cohort study included patients with recent amaurosis fugax, hemispheric transient ischemic attack, or nondisabling stroke in the internal carotid artery territory and an ipsilateral carotid stenosis of <70%, who were not scheduled for carotid revascularization procedure. One hundred patients, recruited between 2010 and 2012, underwent a 3-T high-resolution carotid magnetic resonance imaging. We documented clinical patient characteristics and performed multivariable logistic regression analysis to investigate their association with IPH. Results-IPH was observed in 45 patients (45%) in 1 or both carotid arteries. Male sex and the use of antiplatelet agents before the index event were associated with IPH in univariable analysis. In a multivariable analysis, only previous use of antiplatelet agents was significantly associated with IPH (odds ratio, 2.71; 95% confidence interval, 1.12-6.61). Risk factors of atherosclerotic arterial disease, including a history of symptomatic arterial diseases, were not associated with IPH. Conclusions-In this cohort of 100 patients with recently symptomatic carotid stenosis, the previous use of antiplatelet agents is associated with carotid IPH on magnetic resonance imaging. Antiplatelet therapy may in...

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Section: December 2015mentioning

confidence: 66%

“…[7][8][9] In none of them, the association with antiplatelet therapy was described. One study in 100 symptomatic patients with >30% carotid stenosis found statin use to be negatively associated with IPH but did not record the use of antiplatelet agents.…”

Section: December 2015mentioning

confidence: 99%

Use of Antiplatelet Agents Is Associated With Intraplaque Hemorrhage on Carotid Magnetic Resonance Imaging

Liem

Schreuder

Dijk

et al. 2015

Stroke

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“…Four other studies have reported an association of IPH with antiplatelet or anticoagulant use (Table I in the online-only Data Supplement), in two of which the data were adjusted for age and sex. Derksen et al 14 found that coumarin derivative use was associated with IPH in carotid endarterectomy specimens (OR: 1.99 [1.05, 3.74]; p=0.03). Note that 93% of the subjects were on antiplatelet therapy as the study population were surgery patients.…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure Is a Major Modifiable Risk Factor Implicated in Pathogenesis of Intraplaque Hemorrhage

Sun

Cantón

Balu

et al. 2016

ATVB

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Objective Effective prevention and management strategies of intraplaque hemorrhage (IPH) remain elusive due to our limited knowledge regarding its etiology and contributing factors. This hypothesis-generating study aimed to investigate associations between cardiovascular risk factors and IPH for improved understanding of the pathogenesis of IPH. Approach and Results Asymptomatic subjects with 16–79% stenosis on ultrasound underwent carotid magnetic resonance imaging (MRI) using a large-coverage, three-dimensional MRI protocol. Individual plaques (maximum thickness>1.5 mm) in bilateral carotid arteries were identified and presence of IPH was determined. From 80 subjects, 176 de novo plaques were measured, of which 38 (21.6%) contained IPH. Blood pressure (BP), primarily low diastolic BP, was associated with IPH in multivariate analysis adjusted for age, sex, and plaque size (odds ratio [OR with 95% confidence interval] per 10 mmHg ↑: 0.51 [0.30–0.88]), which was little changed after adjusting for antihypertensive use and systemic atherosclerosis. Antiplatelet use was associated with IPH in age and sex-adjusted models (p=0.018), for which a trend remained after considering plaque size and past medical history (OR for aspirin alone vs. none: 3.1 [0.66–14.8]; OR for clopidogrel or dual therapy vs. none: 5.3 [0.80–35.0]; p=0.083). Conclusions Low diastolic BP was independently associated with IPH, which was unlikely due to treatment difference or BP changes from systemic atherosclerosis. Hemodynamic changes from lowering diastolic BP may be the pathophysiological link. Prospective serial studies are needed to assess whether BP and antiplatelet use are associated with the development of new or repeated IPH.

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“…This instability was probably precipitated by IVrtPA, as this treatment can favor intraplaque hemorrhage through thrombolytic action, similar to anticoagulants [12]. In addition, IV-rtPA promotes matrix metalloproteinases (MMPs), especially MMP-2 and MMP-9, thus increasing extracellular matrix degradation, fibrous cap rupture, and intraplaque hemorrhage [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

High-resolution MRI: detection of a culprit plaque after recurrent thrombolysis

et al. 2015

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Age and coumarin-type anticoagulation are associated with the occurrence of intraplaque hemorrhage, while statins are associated less with intraplaque hemorrhage: A large histopathological study in carotid and femoral plaques

Cited by 35 publications

References 27 publications

Use of Antiplatelet Agents Is Associated With Intraplaque Hemorrhage on Carotid Magnetic Resonance Imaging

Use of Antiplatelet Agents Is Associated With Intraplaque Hemorrhage on Carotid Magnetic Resonance Imaging

Blood Pressure Is a Major Modifiable Risk Factor Implicated in Pathogenesis of Intraplaque Hemorrhage

High-resolution MRI: detection of a culprit plaque after recurrent thrombolysis

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