Ali Haydar Baykan, Sukru Sahin, Ali Zeynel Abidin TAK

Evaluation of cerebral microbleeds in patients using rivaroxaban for cardioembolism prophylaxis in non-valvular atrial fibrillation

Cerebral microbleeds (CMBs) are associated with an increased risk of ischemic and particularly hemorrhagic stroke and are considered a marker of cerebrovascular disease in cranial magnetic resonance imaging (MRI). Rivaroxaban is a new-generation oral anticoagulant and a direct inhibitor of Factor Xa. In this study, we aimed to evaluate the frequency of CMBs in patients using rivaroxaban to prevent cardiac embolism in non-valvular atrial fibrillation. Seventy-four patients using rivaroxaban and 64 controls were included in the study. The group using rivaroxaban had been using medication for at least 6 months. Susceptibility Weighted Angiography (SWAN) sequence was taken from all participants in a 1.5 Tesla MR device to detect CMBs. In the rivaroxaban group, the frequency of CMBs was significantly higher than the control group (p= 0.028), and it increased with the increasing duration of rivaroxaban use (p=0.005). Also, in the rivaroxaban group, there was the frequency of CMBs in specific areas such as the frontal lobe, basal ganglia, and thalamus compared with the control group participants. Since it is known that presence of CMBs increase the risk of stroke, we conclude that caution should be taken in patients who are on rivaroxaban for prophylaxis of cardiac thromboembolism. However, we also believe that this finding needs to be confirmed in studies including larger patient series.

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