Objective: To investigate whether oral anticoagulant therapy (OAT) is related to a higher prevalence and incidence of cerebral microbleeds. Furthermore, to investigate whether maximum international standardized ratios (INR) values and variability in INR among OAT users associate with the presence of microbleeds. Background: OAT is widely used to treat people with thromboembolic diseases but is also a known risk factor for intracerebral hemorrhages. Cerebral microbleeds are considered markers of bleeding prone vessels, and their presence may increase the risk of intracerebral hemorrhages. It remains undetermined whether OAT is a risk factor for subclinical microbleeds in the general population.Methods: In the population-based Rotterdam Study information on outpatient oral anticoagulant drug use was obtained from automated pharmacy records. OAT users were monitored in regional anticoagulant clinics, and INR values were measured in consecutive visits. For each participant the highest measured INR value was assessed. Consecutive INR values were used to calculate variability in INR. Presence and location of microbleeds were rated on brain magnetic resonance imaging. A total of 4945 participants aged 45 years and over were included in the cross-sectional analysis. Of these, 831 follow-up examinations were available for longitudinal analysis. We used logistic regression, adjusting for age, sex and cardiovascular risk to investigate the association of OAT with prevalent and incident microbleeds.Results: OAT users had a higher prevalence (age and sex adjusted odds ratio 1.70, 95% CI 1.24-2.34) and incidence (odds ratio 2.53, 95% CI 1.09-5.85) of deep or infratentorial microbleeds compared to never-users. Among anticoagulant drug users, higher maximum INR values and a greater variability in INR was related to a higher prevalence of microbleeds.Conclusions: OAT relates to both prevalent and incident microbleeds. Furthermore, maximum INR values and variability in INR are risk factors for microbleeds, particularly deep or infratentorial microbleeds.Study Supported by: Erasmus Medical Center;Research Institute for Diseases in the Elderly;Ministry of Education, Health,Welfare and Sports.
Disclosure: Dr. Akoudad has nothing to disclose. Dr. Darweesh has nothing to disclose. Dr. Leening has nothing to disclose. Dr. Koudstaal has nothing to disclose. Dr. Hofman has received personal compensation in an editorial capacity for the European Journal of Epidemiology. Dr. Van Der Lugt has nothing to disclose. Dr. Stricker has nothing to disclose. Dr. Ikram has nothing to disclose. Dr. Vernooij has nothing to disclose.
Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/P5.004?rss=1
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