{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T22:00:14Z","timestamp":1788904814016,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T00:00:00Z","timestamp":1681689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004362","name":"Schweizerische Herzstiftung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004362","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Cerebral microbleeds are associated with the risks of ischemic stroke and intracranial hemorrhage, causing clinical dilemmas for antithrombotic treatment decisions. We aimed to evaluate the risks of intracranial hemorrhage and ischemic stroke associated with microbleeds in patients with atrial fibrillation treated with vitamin K antagonists, direct oral anticoagulants, antiplatelets, and combination therapy (i.e. concurrent oral anticoagulant and antiplatelet).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included patients with documented atrial fibrillation from the pooled individual patient data analysis by the Microbleeds International Collaborative Network. Risks of subsequent intracranial hemorrhage and ischemic stroke were compared between patients with and without microbleeds, stratified by antithrombotic use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 7,839 patients were included. The presence of microbleeds was associated with an increased relative risk of intracranial hemorrhage (adjusted hazard ratio [aHR]\u2009=\u20092.74, 95% confidence interval\u2009=\u20091.76\u20134.26) and ischemic stroke (aHR\u2009=\u20091.29, 95% confidence interval\u2009=\u20091.04\u20131.59). For the entire cohort, the absolute incidence of ischemic stroke was higher than intracranial hemorrhage regardless of microbleed burden. However, for the subgroup of patients taking combination of anticoagulant and antiplatelet therapy, the absolute risk of intracranial hemorrhage exceeded that of ischemic stroke in those with 2 to 4 microbleeds (25 vs 12 per 1,000 patient\u2010years) and \u2265\u200911 microbleeds (94 vs 48 per 1,000 patient\u2010years).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Patients with atrial fibrillation and high burden of microbleeds receiving combination therapy have a tendency of higher rate of intracranial hemorrhage than ischemic stroke, with potential for net harm. Further studies are needed to help optimize stroke preventive strategies in this high\u2010risk group. ANN NEUROL 2023;94:61\u201374<\/jats:p><\/jats:sec>","DOI":"10.1002\/ana.26642","type":"journal-article","created":{"date-parts":[[2023,3,17]],"date-time":"2023-03-17T07:19:35Z","timestamp":1679037575000},"page":"61-74","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation"],"prefix":"10.1002","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3489-3201","authenticated-orcid":false,"given":"Yannie","family":"Soo","sequence":"first","affiliation":[{"name":"Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital The Chinese University of Hong Kong  Shatin Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4362-2497","authenticated-orcid":false,"given":"Annaelle","family":"Zietz","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Centre University Hospital Basel and University of Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Yiu","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital The Chinese University of Hong Kong  Shatin Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent C. T.","family":"Mok","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital The Chinese University of Hong Kong  Shatin Hong Kong"},{"name":"Gerald Choa Neuroscience Institute, Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Science, Lau Tat\u2010chuen Research Centre of Brain Degenerative Diseases in Chinese The Chinese University of Hong Kong  Hong Kong SAR Hong\u00a0Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9475-2208","authenticated-orcid":false,"given":"Alexandros A.","family":"Polymeris","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Centre University Hospital Basel and University of Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3890-3849","authenticated-orcid":false,"given":"David","family":"Seiffge","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital University Hospital Bern, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gareth","family":"Ambler","sequence":"additional","affiliation":[{"name":"Department of Statistical Science University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duncan","family":"Wilson","sequence":"additional","affiliation":[{"name":"Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK New Zealand Brain Research Institute  Christchurch New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas Wai Hong","family":"Leung","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital The Chinese University of Hong Kong  Shatin Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suk Fung","family":"Tsang","sequence":"additional","affiliation":[{"name":"Division of Neurology, 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