| Objective: Atrial fibrillation(AF)is a common type of arrhythmia,non-valvular atrial fibrillation(NVAF)is a common type of AF,and acute ischemic stroke(AIS)is the most common complication.Long-term oral anticoagulants for patients with AF-related stroke: Warfarin,new oral anticoagulants(NOACS)can gain definite benefit.Cerebral microhemorrhages(CMBS)is one of the imaging markers of cerebral microangiopathy,and is considered as a predictor of symptomatic cerebral hemorrhage.The clinical data of AIS and CMBs patients with NVAF were retrospectively collected to observe the incidence of symptomatic intracranial hemorrhage(ICH)as the end-point after 90 days of anticoagulant therapy.The aim of this study was to investigate the safety of AIS patients with NVAF and CMBs with anticoagulant therapy.Methods: This study collected clinical data of AIS patients who were hospitalized in Liaoning Provincial People’s Hospital from April 2016 to November 2020.All AIS patients completed routine head MRI sequence and head susceptibility weighted imaging(SWI)sequence examination.The included AIS patients were divided into CMBs group and no CMBs group based on SWI findings.Complete clinical data mainly include general basic information: age and gender;vascular risk factors: history of hypertension,diabetes,smoking,drinking,past stroke(including ischemic and hemorrhagic);NIHSS of AIS patients Score,anticoagulation score(CHA2DS2-VASc)and bleeding risk score(HAS-BLEDS);imaging indicators: severity of CMBs,lesion location.The type,dose,and number of days of oral anticoagulants;the observed endpoint event is the occurrence of ICH during hospitalization,discharge,and 90 days after taking the drug.Statistical analysis was performed by SPSS24.0 software.The mean and standard deviation are accurate to significant digits,that is,the reliable number plus an estimated digit;the percentage is accurate to one decimal place;the χ~2 value,t value,P value,OR value,and confidence interval are all accurate to three decimal places.Results: From April 2016 to November 2020,the clinical data of 90 patients with AIS and oral anticoagulants in Liaoning provincial People’s hospital were collected,and 83 patients were enrolled in the study.The mean age of the patients was 77.3 ± 7.7 years,47 males(56.6%)and 56 CMBs(67.5%).According to the severity(number of CMBs),the CMBs group was divided into mild(1-2 CMBs)group(23 cases,27.7%),moderate(3-10 CMBs)group(21 cases,25.3%)and severe(> 10 CMBs)group(12 cases,14.5%),the patients were divided into lobar group(20 cases,24.1%),deep or infratentorial group(13 cases,15.7%)and mixed group(23 cases,27.7%).There were 2 patients with end-point events: 1 on the 64 th day after taking warfarin and 1 on the 82nd day after taking NOACs.All patients had severe CMBS and were in mixed sites.Univariate analysis showed that the proportion of hypertension history in CMBs group was higher than that in CMBs group(P < 0.05),but it was not an independent risk factor for ICH(OR = 0.824,95% CI: 0.076-1.573,P = 0.312),compared with 1-2 CMBs and 3-10 CMBs,the incidence of ICH was higher(P < 0.05),and the incidence of ICH was higher in patients with CMBs in mixed sites,but it was lower in patients with lobar or deep and supratentorial lesions,there was no significant difference(P > 0.05).The incidence of ICH in CMBs group was higher than that in non-CMBs group(P > 0.05),but the incidence of ICH in CMBs group was higher than that in non-CMBs group(P > 0.05).Conclusion: AIS patients with NVAF have a higher incidence of CMBs,and a history of hypertension is associated with the occurrence of CMBs.When the number of CMBs is more than 10,oral anticoagulant may not safe.The location of CMBs and the type of anticoagulant do not affect the safety of oral anticoagulant. |
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