Effect of apixaban on brain infarction and microbleeds: AVERROES-MRI assessment study

O’Donnell, Martin; Eikelboom, John W.; Yusuf, Salim; Diener, Hans‐Christoph; Hart, Robert G.; Smith, Eric E.; Gladstone, David J.; Sharma, Mukul; Dias, Rafael; Flaker, Greg C.; Avezum, Álvaro; Zhu, Jun; Lewis, Gayle; Connolly, Stuart J.

doi:10.1016/j.ahj.2016.03.019

Cited by 58 publications

(36 citation statements)

References 23 publications

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“…In the only randomised comparison of a NOAC with aspirin, in patients considered unsuitable for warfarin, apixaban was more effective at preventing thrombotic events with no difference in rates of overall bleeding or intracranial bleeding. 136 In an MRI substudy of AVERROES (Apixaban Versus Acetylsalicylic Acid [ to Prevent Stroke in Atrial Fibrillation Patients Who Have Failed or Are Unsuitable for Vitamin K Antagonist Treatment), 137 the number of new microbleeds was also not different between patients assigned to apixaban versus aspirin. Finally, the use of devices to occlude the left atrial appendage could be considered in eligible patients with atrial fibrillation and history of ICH, 133 although the optimal postimplantation antithrombotic strategy has not been defined in prospective studies in patients with CAA.…”

Section: Management and Treatment Dilemmasmentioning

confidence: 99%

The increasing impact of cerebral amyloid angiopathy: essential new insights for clinical practice

Banerjee

Carare

Cordonnier

et al. 2017

J Neurol Neurosurg Psychiatry

182

137

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Cerebral amyloid angiopathy (CAA) has never been more relevant. The last 5 years have seen a rapid increase in publications and research in the field, with the development of new biomarkers for the disease, thanks to advances in MRI, amyloid positron emission tomography and cerebrospinal fluid biomarker analysis. The inadvertent development of CAA-like pathology in patients treated with amyloid-beta immunotherapy for Alzheimer’s disease has highlighted the importance of establishing how and why CAA develops; without this information, the use of these treatments may be unnecessarily restricted. Our understanding of the clinical and radiological spectrum of CAA has continued to evolve, and there are new insights into the independent impact that CAA has on cognition in the context of ageing and intracerebral haemorrhage, as well as in Alzheimer’s and other dementias. While the association between CAA and lobar intracerebral haemorrhage (with its high recurrence risk) is now well recognised, a number of management dilemmas remain, particularly when considering the use of antithrombotics, anticoagulants and statins. The Boston criteria for CAA, in use in one form or another for the last 20 years, are now being reviewed to reflect these new wide-ranging clinical and radiological findings. This review aims to provide a 5-year update on these recent advances, as well as a look towards future directions for CAA research and clinical practice.

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Section: Management and Treatment Dilemmasmentioning

confidence: 99%

The increasing impact of cerebral amyloid angiopathy: essential new insights for clinical practice

Banerjee

Carare

Cordonnier

et al. 2017

J Neurol Neurosurg Psychiatry

182

137

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“…In recent studies, antiplatelets (34)(35)(36) and anticoagulants (36,37) patients over a median of 18 months follow-up showed that baseline CMBs are associated with an increased risk of both IS (pooled RR 1.8; 95% CI 1.4 to 2.5) and ICH (pooled RR 6.3; 95% CI 3.5 to 11.4) (27) . The risk ratio for both IS and ICH increased with CMB burden, but more steeply for ICH than IS: in individuals with >5 CMBs the RR of IS was 2.7, while that of ICH was 14.1 ( Figure 3).…”

Section: Ischaemic Stroke and Tia Populationsmentioning

confidence: 99%

Antithrombotic therapy in patients with cerebral microbleeds

Wilson¹,

Werring

2017

Current Opinion in Neurology

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“…Although our patient had adverse bleeding events with warfarin several years earlier, he was successfully treated with edoxaban [17,18]. Rates of subdural and subarachnoid hemorrhage seem to be lower with DOAC than with warfarin [19].…”

Section: Discussionmentioning

confidence: 70%

Efficacy and Safety of Direct Oral Anticoagulant for Treatment of Atrial Fibrillation in Cerebral Amyloid Angiopathy

Narita¹,

Amiya²,

Komuro³

2020

Cureus

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A 75-year-old man with a history of atrial fibrillation (AF) and anticoagulant therapy presented with a headache. Cerebral amyloid angiopathy (CAA) was diagnosed after MRI of the brain revealed cortical superficial siderosis, lobar intracerebral hemorrhage, and lobar microbleeds. Anticoagulant therapy was carefully discontinued. Several years later, he was admitted with sudden onset left upper-extremity weakness. In addition to CAA bleeding lesions, a diffusionweighted brain MRI showed multiple infarct lesions of high signal intensity. The administration of edoxaban 7.5 mg/day (later increased up to 30 mg/day) prevented ischemic stroke recurrence without exacerbation of cerebral bleeding. This could indicate that CAA patients with AF who had previous adverse effects from warfarin can safely use newer direct oral anticoagulants, such as edoxaban, to prevent ischemic stroke without danger of cerebral hemorrhage. The superiority of edoxaban as compared with warfarin might be due to its antioxidant effect because vascular oxidative stress plays a causal role in CAA-induced cerebrovascular dysfunction, CAA-induced cerebral hemorrhage, and CAA formation itself. We explained the beneficial effect of edoxaban for CAA by the mechanism of oxidative stress in the paper.

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Effect of apixaban on brain infarction and microbleeds: AVERROES-MRI assessment study

Cited by 58 publications

References 23 publications

The increasing impact of cerebral amyloid angiopathy: essential new insights for clinical practice

The increasing impact of cerebral amyloid angiopathy: essential new insights for clinical practice

Antithrombotic therapy in patients with cerebral microbleeds

Efficacy and Safety of Direct Oral Anticoagulant for Treatment of Atrial Fibrillation in Cerebral Amyloid Angiopathy

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