Our goal was to quantify the independent association of brain microbleeds with future intracranial hemorrhage (ICrH). Microbleed findings on brain magnetic resonance imaging (MRI) may identify distinctive risk factors for ICrH which could inform the anticoagulant therapy decision for AF patients. Our study design includes patients with MRIs for numerous reasons, not limited to evaluation of stroke. The source population was all patients with AF from a nationwide Swedish health care register. Case patients had an ICrH between 2006-2013 and ≥1 brain MRI for an unrelated condition before the ICrH. Each case was matched to four controls who had a brain MRI without a subsequent ICrH. The MRIs were re-reviewed by neuroradiologists. Associations between MRI findings and subsequent ICrH were assessed using logistic regression, adjusting for comorbidities and antithrombotic medications. A total of 78 cases and 312 matched controls were identified; 29 cases and 79 controls had MRI sequences suitable for analysis of microbleeds. Patients with ≥10 microbleeds had a markedly increased risk of ICrH (adjusted odds ratio 14.56; 95% confidence interval: 2.86-74.16, p<0.001). All patients with ≥10 microbleeds had microbleeds in the lobar region and ≥10 lobar microbleeds was associated with intracerebral hemorrhages, univariable OR 8.54 (2.01-36.33), p=0.004. Leveraging a nationwide database with brain imaging obtained prior to ICrH, we identified a strong association between ≥10 microbleeds on brain MRI and subsequent ICrH among AF patients. Lobar brain regions were involved whenever there were ≥10 microbleeds. Brain MRIs may help optimize the anticoagulation decision in selected AF patients.

中文翻译：

---

心房颤动患者的脑 MRI 微出血和颅内出血风险：瑞典病例对照研究

我们的目标是量化脑微出血与未来颅内出血 (ICrH) 的独立关联。脑磁共振成像 (MRI) 的微出血结果可能会识别 ICrH 的独特危险因素，从而为 AF 患者的抗凝治疗决策提供信息。我们的研究设计包括因多种原因接受 MRI 检查的患者，不仅限于评估中风。来源人群是来自瑞典全国医疗保健登记册的所有房颤患者。病例患者在 2006 年至 2013 年期间曾接受过 ICrH，并且在 ICrH 之前有≥1 次脑部 MRI 发现不相关的病症。每个病例都与四名对照组相匹配，这些对照组进行了脑部 MRI 检查，但没有随后进行 ICrH。神经放射科医生重新审查了核磁共振成像。使用逻辑回归评估 MRI 结果与随后的 ICrH 之间的关联，并调整合并症和抗血栓药物。总共确定了 78 例病例和 312 例匹配对照；29 名病例和 79 名对照者具有适合微出血分析的 MRI 序列。微出血 ≥10 次的患者发生 ICrH 的风险显着增加（调整后优势比 14.56；95% 置信区间：2.86-74.16，p<0.001）。所有微出血≥10 次的患者均出现脑叶区微出血，且≥10 次脑叶微出血与脑出血相关，单变量 OR 8.54 (2.01-36.33)，p=0.004。利用 ICrH 之前获得的脑成像全国数据库，我们发现 AF 患者脑部 MRI ≥10 次微出血与随后的 ICrH 之间存在密切关联。每当微出血≥10 次时，脑叶区域就会受到影响。脑部 MRI 可能有助于优化选定的 AF 患者的抗凝决策。