Effectiveness of Nonvitamin K Antagonist Oral Anticoagulants and Warfarin for Preventing Further Cerebral Microbleeds in Acute Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation and At Least One Microbleed: CMB-NOW Multisite Pilot Trial.

Abstract

BACKGROUND:

Nonvitamin K antagonist oral anticoagulants (NOACs) are considered superior, or at least noninferior, to warfarin in preventing stroke or systemic embolism in patients with nonvalvular atrial fibrillation. Here, we recruited acute ischemic stroke patients with nonvalvular atrial fibrillation and at least one cerebral microbleed (CMB), and evaluated the proportion of patients who had an increased number of CMBs (%) after receiving anticoagulant therapy with NOACs or with warfarin for 12 months.

METHODS:

This was a multicenter, prospective, observational cohort study at 20 centers, conducted between 2015 and 2017, in which we recruited 85 patients with at least one CMB detected by 1.5T magnetic resonance imaging (T2*WI) at baseline, who received NOACs or warfarin for at least 12 months. We compared the proportions of patients with increased numbers of CMBs in the NOACs and warfarin treatment groups.

RESULTS:

The proportions of patients with increased numbers of CMBs at month 12 of treatment were 28.6% and 66.7% in the NOACs and warfarin groups, respectively. The new CMBs showed no specific regional localization in either group. In the NOACs and warfarin groups, physicians prescribed lower-than-standard dosing in 13.3% and 50% of the cases, respectively. The administration of reduced doses at physicians' discretion did not appear to alter the incidence of new CMBs.

DISCUSSION:

This is the first evidence to suggest efficacy of NOACs for preventing further CMBs in patients with at least one CMB, although no statistical evaluation was carried out.

• Authors: Mutsumi Yokoyama, Atsushi Mizuma, Tohru Terao, Fumiaki Tanaka, Kazutoshi Nishiyama, Yasuhiro Hasegawa, Eiichiro Nagata, Shigeru Nogawa, Hiroyuki Kobayashi, Noriharu Yanagimachi, Takashi Okazaki, Kazuo Kitagawa, Shunya Takizawa, CMB-NOW Study Investigators
• Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association (J Stroke Cerebrovasc Dis) Vol. 28 Issue 7 Pg. 1918-1925 (Jul 2019) ISSN: 1532-8511 [Electronic] United States
• PMID: 31005561 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Observational Study)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Anticoagulants
• Vitamin K
• Warfarin

Topics

• Administration, Oral
• Aged
• Aged, 80 and over
• Anticoagulants (administration & dosage, adverse effects)
• Atrial Fibrillation (diagnosis, drug therapy, epidemiology)
• Brain Ischemia (diagnostic imaging, drug therapy, epidemiology)
• Female
• Humans
• Incidence
• Intracranial Hemorrhages (diagnostic imaging, epidemiology, prevention & control)
• Japan (epidemiology)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Pilot Projects
• Prospective Studies
• Recurrence
• Risk Factors
• Stroke (diagnostic imaging, drug therapy, epidemiology)
• Time Factors
• Treatment Outcome
• Vitamin K (antagonists & inhibitors)
• Warfarin (administration & dosage, adverse effects)