A Study On The Correlation Between The Treatment Of New Oral Anticoagulants And Cerebral Microbleeds In Acute Ischemic Cerebrovascular Disease Patients With Non-Valvular Atrial Fibrillation

Background: Non-valvular atrial fibrillation(NVAF)is a risk factor for the onset of ischemic stroke(IS).NVAF patients need long-term treatment with oral anticoagulants(OACs)to prevent thromboembolic events.intracranial hemorrhage(ICH)is a fatal and unpredictable complication of anticoagulant therapy.At present,it is believed that the therapeutic effect of new oral anticoagulants(NOACs)in patients with acute ischemic stroke(AIS)complicated with NVAF is better than or equal to warfarin,and its safety is also higher.Cerebral microbleeds(CMBs)are a type of Subclinical damage of the cerebral parenchymal that can predict the risk of ICH,and are characterized by small hemorrhages caused by small intracranial blood vessel injurie.However,there are few reports on CMBs related to the treatment of patients with AIS complicated with NVAF by NOACs.Objective: The purpose of this study is to explore the effects of anticoagulant therapy with rivaroxaban and dabigatran etexilate on the occurrence of CMBs in patients with AIS complicated with NVAF,aiming to compare the safety of anticoagulant therapy with rivaroxaban and dabigatran etexilate.In addition,the risk factors of CMBs in patients with AIS complicated with NVAF are planned to be explored.Methods: We prospectively followed 71 patients with acute ischemic stroke complicated with non-valvular atrial fibrillation who were treated in the Department of Neurology,Zhuji Affifiliated Hospital of Shaoxing University from March 2021 to March 2022 and used rivaroxaban and dabigatran at discharge.Finally,60 patients were included.According to the type of NOACs,they were divided into rivaroxaban group and dabigatran group.Additionally,they were divided into CMBs group and non-CMBs group based on the results of brain susceptibility weighted imaging(SWI)sequences at admission.After follow-up for 12 months,they were re-examined with brain SWI,and correspondingly divided into increased CMBs group and non-increased CMBs group.SPSS 25.0 was employed to statistically analyze the data,with P <0.05 being deemed statistically significant.Results:1.The increase in CMBs showed no statistical significance between the rivaroxaban group(n = 30)and the dabigatran group(n = 30)after anticoagulant therapy for 12 months(P>0.05).2.After anticoagulant therapy for 12 months,the comparison between the increased CMBs group(n = 9)and the non-increased CMBs group(n = 51)revealed that age(t = 2.052,P=0.045),NIHSS score(t =-2.327,P=0.020)and CHA2DS2-VASc score(t =-2.549,P=0.01)had statistically significant differences.Further multivariate logistic regression analysis suggested that the CHA2DS2-VASc score(b = 0.922,OR = 2.515,95% CI:1.181～5.355;P=0.017)was an independent risk factor for the increase in CMBs during the12-month follow-up,and presented a positive correlation.3.At baseline,age(t =-2.091,P=0.041)presented a statistically significant difference between the CMBs group(n = 20)and the non-CMBs group(n = 40).Further multivariate logistic regression analysis indicated a significant difference in age between the two groups.Age(b = 0.076,OR = 1.079,95% CI: 1.006～1.158;P=0.034)was an independent risk factor leading to the occurrence of CMBs,with a positive correlation.4.Incidence of adverse events in the rivaroxaban group and the dabigatran group during the 12-month follow-up: The adverse events included embolic events: IS recurrence in 3patients(the rivaroxaban group,n = 2;the dabigatran group,n = 1),general bleeding events in3 patients(the rivaroxaban group,n = 2;the dabigatran group,n = 1),and adverse reactions in3 patients(the rivaroxaban group,n = 1;the dabigatran group,n = 2).Conclusions:1.The increase in the number of CMBs in the secondary prevention with rivaroxaban and dabigatran for patients with AIS complicated with NVAF was not related to different types of NOACs,and adverse events are low,their safety is equivalent.2.Our results suggest that age is an independent risk factor for the occurrence of CMBs.At the average age of(73.85 ± 9.83)years,the incidence of CMBs increases by 7.9% for every 1 year of age increase.3.CHA2DS2-VASc score is an independent risk factor for newly developed CMBs in anticoagulant therapy for NOACs(rivaroxaban and dabigatran)for 12 months.The incidence of CMBs after anticoagulant therapy for NOACs(rivaroxaban and dabigatran)increases by 2times for each point increase in CHA2DS2-VASc score.