Advancing Bleeding Risk Prediction in Patients with Cerebrovascular and Cardiovascular Diseases Receiving Antithrombotic Therapy

2022 Fiscal Year Final Research Report

• Project/Area Number: 19K17023
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 52020:Neurology-related
• Research Institution: National Cardiovascular Center Research Institute
• Principal Investigator: Tanaka Kanta 国立研究開発法人国立循環器病研究センター, 病院, 医師 (90818402)
• Project Period (FY): 2019-04-01 – 2023-03-31
• Keywords: 出血 / 抗血栓療法 / 脳小血管病

Outline of Final Research Achievements

The Bleeding with Antithrombotic Therapy 2 (BAT2) is a multicenter prospective cohort study that enrolled patients with cerebrovascular and cardiovascular diseases who were taking oral antithrombotics from 52 hospitals nationwide. To investigate the impact of cerebral small vessel disease (SVD) on antithrombotic-related bleeding risks, brain MRI under prespecified conditions was mandatory for all patients at registration. All MRI examinations were interpreted by a central diagnostic committee. 5,378 patients were enrolled between 2016 and 2019, and follow-up was completed in April 2021. Analysis of baseline MRI data showed that albuminuria and reduced estimated glomerular filtration rate were independently associated with higher cerebral SVD burden. Another analysis showed that the total SVD score was predictive for intracranial hemorrhage and probably for extracranial bleeding, suggesting the broader clinical relevance of cerebral SVD as a marker for safe antithrombotic therapy.

Free Research Field

脳血管障害

Academic Significance and Societal Importance of the Research Achievements

本研究により、経口抗血栓薬を内服している脳血管疾患あるいは心血管疾患患者において、アルブミン尿と推算糸球体濾過量の低下が、脳小血管病(SVD)と関連していることが示された。また、フォローアップデータも含めた解析により、脳SVDが、頭蓋内出血だけでなく、消化管出血などの頭蓋外大出血のリスク因子となる可能性が示された。本研究成果から、主に大脳穿通枝領域の小血管病を反映するtotal SVD scoreと全身の高血圧性臓器障害との連関が支持された。また、脳SVDの包括的画像評価は、脳血管のみならず頭蓋外の小血管障害を捉える可能性があり、抗血栓療法を安全に実施する上で有用と考えられる。