Key result
AIS/TIA comprises 82% of strokes on anticoagulants, linking to atherosclerosis while ICH involves small vessel disease.
Why the study?
Data on the relative contribution of clinical and neuroimaging risk factors to acute ischemic stroke versus intracerebral hemorrhage occurring during oral anticoagulant treatment are scarce.
What clinical and neuroimaging risk factors differentiate intracerebral hemorrhage from acute ischemic stroke or TIA in patients on oral anticoagulants?
Cross-Sectional (n=734)
What clinical and neuroimaging risk factors differentiate intracerebral hemorrhage from acute ischemic stroke or TIA in patients on oral anticoagulants?
In patients on oral anticoagulants, ischemic stroke is 5 times more common than ICH and is driven by atherosclerotic burden, whereas ICH is associated with small vessel disease markers and prior ICH.
Differentiates atherosclerotic from small vessel drivers of stroke on OAC; hypothesis-generating and should not yet change practice.
Background Data on the relative contribution of clinical and neuroimaging risk factors to acute ischemic stroke (AIS) versus intracerebral hemorrhage (ICH) occurring on oral anticoagulant treatment are scarce. Methods and Results Cross-sectional study was done on consecutive oral anticoagulant-treated patients presenting with AIS, transient ischemic attack (TIA), or ICH from the prospective observational NOACISP (Novel-Oral-Anticoagulants-In-Stroke-Patients)-Acute registry. We compared clinical and neuroimaging characteristics (small vessel disease markers and atherosclerosis) in ICH versus AIS/TIA (reference) using logistic regression. Among 734 patients presenting with stroke on oral anticoagulant treatment (404 [55%] direct oral anticoagulants, 330 [45%] vitamin K antagonists), 605 patients (82%) had AIS/TIA and 129 (18%) had ICH. Prior AIS/TIA, coronary artery disease, dyslipidemia, and worse renal function were associated with AIS/TIA (adjusted odds ratio [aOR] [95% CI] 0.51 [0.32-0.82], 0.48 [0.26-0.86], 0.55 [0.34-0.89], and 0.82 [0.75-0.90] per 10 mL/min). Prior ICH, older age, higher admission blood pressure, and statin treatment were associated with ICH (aOR [95% CI] 6.33 [2.87-14.04], 1.37 [1.04-1.81] per 10 years, 1.19 [1.10-1.29] per 10 mm Hg, and 1.81 [1.09-3.03]). Cerebral microbleeds and moderate-to-severe white matter hyperintensities contributed more to ICH (aOR [95% CI] 2.77 [1.34-6.18], and 2.62 [1.28-5.63]). Aortic arch, common and internal carotid artery atherosclerosis, and internal carotid artery stenosis ≥50% contributed more to AIS/TIA (aOR [95% CI] 0.54 [0.31-0.90], 0.29 [0.05-0.97], 0.48 [0.30-0.76], and 0.32 [0.13-0.67]). Conclusions In patients presenting with stroke on oral anticoagulant, AIS/TIA was 5 times more common than ICH. A high atherosclerotic burden (indicated by cardiovascular comorbidities and extracranial atherosclerosis) and prior AIS/TIA contributed more to AIS/TIA, while small vessel disease markers and prior ICH were stronger determinants for ICH. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02353585.
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Schaub et al. (2022) conducted a cross-sectional in Stroke on oral anticoagulant treatment (n=734). Clinical and neuroimaging risk factors vs. AIS/TIA (reference) was evaluated on Clinical and neuroimaging characteristics associated with ICH versus AIS/TIA. In patients presenting with stroke on oral anticoagulants, AIS/TIA was more common than ICH (82% vs 18%), with atherosclerosis driving AIS/TIA and small vessel disease markers driving ICH.
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