Statins do not increase Markers of Cerebral Angiopathies in patients with Cardioembolic Stroke

Martí‐Fàbregas, Joan; Medrano-Martorell, Santiago; Martín-Merino, Elisa; Prats‐Sánchez, Luís; Marín, Rebeca; Delgado‐Mederos, Raquel; Camps‐Renom, Pol; Martínez‐Domeño, Alejandro; Gómez-Choco, Manuel; Lara, Lidia; Casado-Naranjo, Ignacio; Cánovas, David; Torres, María José; Freijó, Marimar; Calleja, Ana; Bravo, Yolanda; Cocho, Dolores; Rodríguez-Campello, Ana; Zandio, Beatriz; Fuentes, Blanca; Felipe, Alicia de; Llull, Laura; Maestre, J.; Hernández, Maria Valdés; Garcés, Moisès; Arce-Borda, Ana María de; Palomeras, Ernest; Rodríguez‐Yáñez, Manuel; Díaz-Maroto, Inmaculada; Serrano, Marta; Fernández-Domínguez, Jéssica; Sanahuja, Jordi; Purroy, Francisco; Zedde, Marialuisa; Delgado-Mengual, Jordi; Gich, Ignasi

doi:10.1038/s41598-018-20055-3

Cited by 13 publications

(9 citation statements)

References 41 publications

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“…Our study showed that antiplatelet use was associated with presence of CMBs in ischemic stroke patients with AF/RHD. Although controversies existed in the literature (14, 26–28), our finding is consistent with three recent meta-analyses, which all showed similar associations in patients with ischemic stroke or TIA (15, 29, 30). Some of the previous studies suggested that different type of antiplatelets may have different effects on development of CMBs.…”

Section: Discussionsupporting

confidence: 92%

Prior Antithrombotic Therapy Is Associated With Cerebral Microbleeds in Ischemic Stroke Patients With Atrial Fibrillation and/or Rheumatic Heart Disease

et al. 2019

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Background and purpose: Cerebral microbleeds (CMBs) could contribute to an increased risk of intracerebral hemorrhage in patients with antithrombotic therapy (antiplatelets or anticoagulants). Antithrombotic agents are commonly prescribed to the patients with atrial fibrillation (AF) and/or rheumatic heart disease (RHD) for preventing ischemic stroke. However, the impact of antithrombotic therapy on CMBs remained controversial. We aimed to explore the association between the prevalence of CMBs and prior antithrombotic therapy in ischemic stroke patients with AF and/or RHD.Materials and Methods: Ischemic stroke patients with AF and/or RHD within 7 days of onset from two hospitals were enrolled. Clinical information, prior use of antiplatelets or anticoagulation, presence and location of CMBs on susceptibility weighted imaging were recorded. We investigated the association of antithrombotic use with the presence or location of CMBs using multivariable logistic regression.Results: A total of 160 patients (68 males; median age, 71 years) were included. CMBs were observed in 90 (56.3%) patients, of whom 37 were with strictly lobar CMBs and 53 were with deep or infratentorial CMBs. There was a significant difference in antiplatelet use between patients with and without CMBs (33.3 vs. 11.4%, P = 0.001), but not found in anticoagulants. Prior use of antiplatelets was independently associated with the presence of CMBs (OR 3.075, 95% CI 1.175–8.045, P = 0.022) and especially strictly lobar CMBs (OR 2.635, 95% CI 1.050–6.612, P = 0.039) in multivariate analysis.Conclusions: The present study suggests that CMBs are common in ischemic stroke patients with AF and/or RHD and prior antiplatelet use may relate to the presence of CMBs predominantly in the strictly lobar region. Whether anticoagulants could cause CMBs need to be determined in future longitudinal studies.

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Section: Discussionsupporting

confidence: 92%

Prior Antithrombotic Therapy Is Associated With Cerebral Microbleeds in Ischemic Stroke Patients With Atrial Fibrillation and/or Rheumatic Heart Disease

et al. 2019

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“…1). After obtaining the full texts of potentially eligible for inclusion studies we excluded 3 studies not providing outcomes of interest and/or reporting overlapping data with other publications (Table 1) [12][13][14], leaving a total of 7 eligible studies (2 RCTs, 1 prospective cohort study and 4 retrospective cohort studies) including a total of 3734 participants (Table 2) [15][16][17][18][19][20][21]. Three of the studies included 849 patients with history of ischemic stroke (IS) or transient ischemic attack (TIA) [15,17,19,21], 79 of whom had evidence of confluent white matter hyperintensities on baseline neuroimaging [21].…”

Section: Resultsmentioning

confidence: 99%

“…Three of the studies included 849 patients with history of ischemic stroke (IS) or transient ischemic attack (TIA) [15,17,19,21], 79 of whom had evidence of confluent white matter hyperintensities on baseline neuroimaging [21]. Two of the studies included 252 patients with spontaneous ICH [17,18], 89 of whom had history of pretreatment with oral anticoagulants [18]. One of the studies recruited 668 patients more than 60 years of age with history of hypertension [16] and one study was communitybased, recruiting 1965 unselected individuals from the general population [20].…”

Section: Resultsmentioning

confidence: 99%

Statin treatment and cerebral microbleeds: A systematic review and meta-analysis

Katsanos

Lioutas

Charidimou

et al. 2021

Journal of the Neurological Sciences

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Although statins have been associated with increased risk of spontaneous intracerebral hemorrhage, their relationship with cerebral microbleeds (CMBs) formation is poorly understood. We systematically reviewed previously published studies reporting on the association between CMBs presence and current statin use.We performed a systematic search in MEDLINE and SCOPUS databases on October 24, 2019 to identify all cohorts from randomized-controlled clinical trials or observational studies reporting on CMB prevalence and statin use. We extracted cross-sectional data on CMBs presence, as provided by each study, in association to the history of current statin use. Random effects model was used to calculate the pooled estimates. We included 7 studies (n = 3734 participants): unselected general population [n = 1965], ischemic stroke [n = 849], hemorrhagic stroke [n = 252] and patients with hypertension over the age of 60 [n = 668]. Statin use was not associated with CMBs presence in either unadjusted (OR = 1.15, 95%CI: 0.76-1.74) or adjusted analyses (OR = 1.09, 95%CI: 0.64-1.86). Statin use was more strongly related to lobar CMB presence (OR = 2.01, 95%CI: 1.48-2.72) in unadjusted analysis. The effect size of this association was consistent, but no longer statistically significant in adjusted analysis that was confined to two eligible studies (OR = 2.26, 95%CI: 0.86-5.91). Except for the analysis on the unadjusted probability of lobar CMBs presence, considerable heterogeneity was present in all other analyses (I 2 > 60%). Our findings suggest that statin treatment seems not to be associated with CMBs overall, but may increase the risk of lobar CMB formation. This hypothesis deserves further investigation within magnetic resonance imaging ancillary studies of randomized trials.

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“…124 Similarly, statin pretreatment was not associated with CMB presence among patients who had an acute cardioembolic stroke who were anticoagulation-naïve. 125 Finally, there are conflicting data regarding the potential association of statin pretreatment with CMB presence or burden in patients with acute ICH (spontaneous 126 or anticoagulation-associated 127 ). In view of the former associations, CMB presence or high burden on brain MRI should not be used to withhold statin therapy for otherwise eligible patients in the settings of primary and secondary stroke prevention.…”

Section: Lipid-lowering Therapies and Cmbsmentioning

confidence: 99%

Cerebral microbleeds: from depiction to interpretation

Puy

Pasi

Rodrigues

et al. 2021

J Neurol Neurosurg Psychiatry

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Cerebral microbleeds (CMBs) are defined as hypointense foci visible on T2*-weighted and susceptible-weighted MRI sequences. CMBs are increasingly recognised with the widespread use of MRI in healthy individuals as well as in the context of cerebrovascular disease or dementia. They can also be encountered in major critical medical conditions such as in patients requiring extracorporeal mechanical oxygenation. The advent of MRI-guided postmortem neuropathological examinations confirmed that, in the context of cerebrovascular disease, the vast majority of CMBs correspond to recent or old microhaemorrhages. Detection of CMBs is highly influenced by MRI parameters, in particular field strength, postprocessing methods used to enhance T2* contrast and three dimensional sequences. Despite recent progress, harmonising imaging parameters across research studies remains necessary to improve cross-study comparisons. CMBs are helpful markers to identify the nature and the severity of the underlying chronic small vessel disease. In daily clinical practice, presence and numbers of CMBs often trigger uncertainty for clinicians especially when antithrombotic treatments and acute reperfusion therapies are discussed. In the present review, we discuss those clinical dilemmas and address the value of CMBs as diagnostic and prognostic markers for future vascular events.

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Statins do not increase Markers of Cerebral Angiopathies in patients with Cardioembolic Stroke

Cited by 13 publications

References 41 publications

Prior Antithrombotic Therapy Is Associated With Cerebral Microbleeds in Ischemic Stroke Patients With Atrial Fibrillation and/or Rheumatic Heart Disease

Prior Antithrombotic Therapy Is Associated With Cerebral Microbleeds in Ischemic Stroke Patients With Atrial Fibrillation and/or Rheumatic Heart Disease

Statin treatment and cerebral microbleeds: A systematic review and meta-analysis

Cerebral microbleeds: from depiction to interpretation

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