Small vessel disease burden and intracerebral haemorrhage in patients taking oral anticoagulants

Journal of Neurology, Neurosurgery & Psychiatry

Fecha de publicación: 19 de marzo de 2021

Autores: David J Seiffge, Duncan Wilson, Gareth Ambler, Gargi Banerjee, Isabel Charlotte Hostettler, Henry Houlden, Clare Shakeshaft, Hannah Cohen, Tarek A Yousry, Rustam Al-Shahi Salman, Gregory Lip, Martin M Brown, Keith Muir, H.R Jäger, David J Werring

DOI: Journal of Neurology, Neurosurgery & Psychiatry 2021;92:805-814.

Background: Cerebral small vessel disease (SVD) accounts for the vast majority of non-traumatic spontaneous intracerebral haemorrhage (ICH), accounting for 77% in patients aged 70 years or younger in a study from Western Europe and 77%–85% of patients aged 18 years or older in a study from Western Europe and the USA. Meta-analyses of randomised controlled trials suggest that oral anticoagulants—vitamin K antagonists and direct oral anticoagulants (apixaban, dabigatran, edoxaban and rivaroxaban)—are a risk factor for ICH. However, there is no evidence that anticoagulants can cause arterial rupture, vascular fragility or inhibit vascular repair.