Global Cortical Atrophy Is Associated with an Unfavorable Outcome in Stroke Patients on Oral Anticoagulation

Since you did nothing to prevent this problem from happening it was totally useless research. You're all fired.

Global Cortical Atrophy Is Associated with an Unfavorable Outcome in Stroke Patients on Oral Anticoagulation

Marta Kubacka a, b 

 Annaelle Zietz c 

 Sabine Schaedelin d  

Alexandros A. Polymeris c 

 Lisa Hert c, e
Johanna Lieb f  

Benjamin Wagner c  

David Seiffge c, g 

 Christopher Traenka c, h
Valerian L. Altersberger c, h  

Tolga Dittrich c  

Joachim Fladt c  

Urs Fisch c 

 Sebastian Thilemann c
Gian Marco De Marchis c  

Henrik Gensicke c, h  

Leo H. Bonati c  

Philippe Lyrer c
Stefan T. Engelter c, h  

Nils Peters a, c, h
a Stroke Center, Klinik Hirslanden, Zürich, Switzerland;  

b University of Basel, Basel, Switzerland; 

 c Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland; 

 d Clinical Trial Unit, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland;
e Department of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland;  

f Department of
Neuroradiology, University Hospital Basel, Basel, Switzerland;  

g Department of Neurology and Stroke Center,
Inselspital, Bern, Switzerland;  

h Neurology and Neurorehabilitation, University Department of Geriatric Medicine
Felix Platter, University of Basel, Basel, Switzerland

Abstract

Introduction:  

 

Measures of cerebral small vessel disease (cSVD), such as white matter hyperintensities (WMH) and cerebral microbleeds (CMB), are associated with an unfavorable clinical course in stroke patients on oral anticoagulation (OAC) for atrial fibrillation (AF). Here, we investigated whether similar findings can be observed for global cortical atrophy (GCA).  

 

Methods:  

 

Registry-based prospective observational study of 320 patients treated with OAC following AF stroke. Patients underwent magnetic resonance imaging (MRI) allowing assessment of GCA. Using the simplified visual Pasquier scale, the severity of GCA was categorized as
follows: 0: no atrophy, 1: mild atrophy; 2: moderate atrophy, and 3: severe atrophy. Using adjusted logistic and Cox regression analysis, we investigated the association of GCA us-
ing a composite outcome measure, comprising: (i) recurrent acute ischemic stroke (IS); (ii) intracranial hemorrhage (ICH);
and (iii) death.  

 

Results:  

 

In our time to event analysis after adjusting for potential confounders (i.e., WMH, CMB, age, sex, diabetes, arterial hypertension, coronary heart disease, hyperlipidemia, and antiplatelet use), GCA was associated with an increased risk for the composite outcome in all three degrees of atrophy (grade 1: aHR 3.95, 95% CI 1.34–11.63, p = 0.013; grade 2: aHR 3.89, 95% CI 1.23–12.30, p = 0.021; grade 3: aHR 4.16, 95% CI 1.17–14.84, p = 0.028).  

Conclusion:  

 

GCA was associated with our composite outcome also after adjusting for other cSVD markers (i.e., CMB, WMH) and age, indicating that GCA may potentially serve as a prognosti marker for stroke patients with atrial fibrillation on oral anticoagulation.