Stroke : After a stroke, patients treated with atrial fibrillation anticoagulants, small vascular disease increases the risk of stroke recurrence

Although oral anticoagulants (OAC) are very effective for secondary prevention of ischemic stroke or transient cerebral ischemic (TIA) associated with atrial fibrillation, some studies have shown that despite OAC, the risk of relapsed cerebrovascular events remains high (4.7%-7.7%/year).
Although anticoagulant therapy is effective for atrial fibrillation, recurrent isothermal strokes may reflect inadequate anticoagulant treatment or stroke-related mechanisms, as atrial fibrillation usually exists in the same way as other related diseases, including atherosclerosis or cerebrovascular disease (SVD).
a recent case-control study showed that in addition to atrial fibrillation, the prevalence of stroke from other causes in anticoagulant therapy was 32.7 percent, with strokes caused by SVD, a small vascular disease, accounting for 10.4 percent.
SVD is associated with age, hypertension, stroke, and cognitive impairment and can be detected and quantified by MRI biomarkers, including space around blood vessels, micro-bleeding of the brain, cavity gaps, and white matter hypersetic lesions.
Previous studies of unseconded ischemic stroke populations have shown that vascular clearance (BGPVS), CMB load, severe WMH, and multiple cavity gaps (lacune) around the substrate nerve section are associated with relapsed ischemic stroke.
, SVD was not associated with ischemic stroke risk in patients with intracranial artery stenosis.
Houwei Du et al., of UCL UK, explored the relationship between SVD and re-stroke in patients treated with atrial fibrillation after stroke or TIA, based on the Study of CROMIS-2 (Clinical Institute of Microbleeds in Study Stroke).
they included 1,419 patients who had had a stroke or TIA and evaluated SVD markers on baseline MRIs: vascular clearance around the substrate nerve section (number ≥11); Micro-hemorrhage of the brain (≥1); lacune; White high signal lesions.
using the Cox model, the relationship between heart failure, hypertension, age, age, 75, diabetes, stroke, vascular disease, age 65-74 years, and gender scores was analyzed to analyze the relationship between SVD MRI markers and the risk of relapsed ishy stroke.
results showed that the rate of ischemic stroke in patients with SVD during follow-up was 2.20/100 years (person-year), while the rate of ischemic stroke in patients without SVD was 0.98/100 years (p s 0.008).
after adjusting for heart failure, hypertension, age, 75 years, diabetes, stroke, vascular disease, 65-74 age group, female score, SVD, SVD, there was still a significant correlation between SVD and ischemic stroke during follow-up (OR=1.89; p = 0.046) ; The risk of recurrence of ischemic stroke increases with an increase in SVD scores (HR=1.33 p=0.023).
importance of this study is that in patients treated with atrial fibrillation anticoagulant after ishemia stroke or TIA, the MRI markers of SVD were associated with an increased risk of re-development of isothermal stroke during follow-up; This suggests that in such a population, timely preventive intervention is conducive to preventing the re-onset of stroke.