Intracranial Hemorrhage Risk with NOACs vs Aspirin

MedicalResearch.com Interview with:
medical researchDr. Michael Lee
Department of Neurology
Chang Gung University College of Medicine
Chang Gung Memorial Hospital Taiwan

MedicalResearch.com: What is the background for this study?

Response: Although NOACs and aspirin are in general protective in different vascular beds, NOACs might be an attractive choice for stroke prevention in certain clinical situations, such as in people without recognized atrial fibrillation, but with an embolic stroke of undetermined source or atrial cardiopathy because of their propensity to also cause stroke through cardiac emboli.

Nonetheless, the benefit of NOACs over aspirin for stroke protection is likely to be less promising in people without atrial fibrillation, as compared to people with atrial fibrillation. Therefore it is even more important to clarify whether individual NOACs with of various doses harbor comparable risks of intracranial hemorrhage with aspirin based on the evidence currently available.

MedicalResearch.com: What are the main findings? 

Response: Rivaroxaban 15-20mg once daily substantially increased the risks of intracranial hemorrhage while rivaroxaban 10mg daily and apixaban 5mg twice daily were not. 

MedicalResearch.com: What should readers take away from your report?

Response: Rivaroxaban 15-20mg once daily possessed substantial higher risks of intracranial hemorrhage than aspirin, its use in people without atrial fibrillation could not be encouraged.  

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: It may be worthwhile to conduct randomized controlled trials comparing certain NOAC (e.g. apixaban 5mg twice daily) and aspirin in patients without atrial fibrillation, but with potential sources of cardiac emboli that can cause stroke.

No disclosures 

Citation:

Huang W, Singer DE, Wu Y, et al. Association of Intracranial Hemorrhage Risk With Non–Vitamin K Antagonist Oral Anticoagulant Use vs Aspirin UseA Systematic Review and Meta-AnalysisJAMA Neurol. Published online August 13, 2018. doi:10.1001/jamaneurol.2018.2215

 

Aug 15, 2018 @ 12:30 pm

 

 

 

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Genetic Variants Increase Risk of Intracerebral Hemorrhage in Patients on Warfarin

Christopher D. Anderson, MD, MMSc Neurocritical Care | Acute Stroke Center for Human Genetic Research Massachusetts General Hospital Harvard Medical School Broad Institute of Harvard and MITMedicalResearch.com Interview with:
Christopher D. Anderson, MD, MMSc
Neurocritical Care | Acute Stroke
Center for Human Genetic Research
Massachusetts General Hospital
Harvard Medical School
Broad Institute of Harvard and MIT

Medical Research: What are the main findings of the study?

Dr. Anderson: Previous studies have linked Apolipoprotein E (APOE) epsilon variants with spontaneous intracerebral hemorrhage (ICH) particularly in the lobar (cortical and subcortical) regions of the brain, but it was not known whether this association would extend to warfarin-related ICH, or whether the risk of intracerebral hemorrhage on warfarin would be multiplicatively compounded by APOE epsilon allele status.  Our results demonstrate that APOE e2 and e4 variants are associated with more than a two-fold risk of lobar ICH for patients on warfarin, in comparison to warfarin-exposed individuals without ICH.  This observed association was strongest when analyzing subjects with definite or probable Cerebral Amyloid Angiopathy (CAA), as defined by the Boston Criteria.  No association between APOE e2 or e4 and non-lobar ICH was identified following our replication phase.  Furthermore, we did not detect an interaction between APOE status and warfarin status in ICH subjects using a case-only design.
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