Worldwide collaboration in the Microbleeds International Collaborative Network
2016; Elsevier BV; Volume: 15; Issue: 11 Linguagem: Inglês
10.1016/s1474-4422(16)30213-7
ISSN1474-4465
Tópico(s)Neurosurgical Procedures and Complications
ResumoWe read with interest the Correspondence calling for international research collaborations on cerebral microbleeds.1Charidimou A Soo Y Heo JH Srikanth V for the META-MICROBLEEDS ConsortiumA call for researchers to join the META-MICROBLEEDS Consortium.Lancet Neurol. 2016; 15: 900Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar Key questions remain about the clinical relevance of these small, usually chronic brain haemorrhages (especially regarding their potential role as a marker of bleeding-prone arteriopathies) and about the intracerebral haemorrhage risk in patients given antithrombotic agents after ischaemic stroke or transient ischaemic attack.2Wilson DCA Ambler G Fox Z et al.Recurrent stroke risk and cerebral microbleed burden in ischemic stroke and TIA: a meta-analysis.Neurology. 2016; (in press).Google Scholar, 3Werring DJ Wilson D Marti-Fabregas J Letter by Werring et al regarding article, "Embolic stroke, atrial fibrillation, and microbleeds: is there a role for anticoagulation?".Stroke. 2016; 47: e176Crossref PubMed Scopus (2) Google Scholar We agree that single-centre studies are unlikely to fully answer all scientific questions about cerebral microbleeds; international collaboration is essential to increase the scale of data available and to maximise scientific and statistical power. Collaborative research networks on cerebral microbleeds have developed over recent years.4Greenberg SM Vernooij MW Cordonnier C et al.Cerebral microbleeds: a guide to detection and interpretation.Lancet Neurol. 2009; 8: 165-174Summary Full Text Full Text PDF PubMed Scopus (1256) Google Scholar We wish to raise awareness of the recently established Microbleeds International Collaborative Network, which arose from two large multicentre inception cohort studies addressing the key question of whether cerebral microbleeds are associated with increased bleeding risk on oral anticoagulants in patients following ischaemic stroke or transient ischaemic attack: Clinical Relevance of Microbleeds in Stroke (CROMIS-2; ClinicalTrials.gov, NCT02513316) and Intracerebral Hemorrhage Due to Oral Anticoagulants: Prediction of the Risk by Magnetic Resonance (HERO; ClinicalTrials.gov, NCT02238470). Together, CROMIS-2 and HERO have successfully recruited more than 2500 patients from over 110 hospitals mainly in the UK and Spain, and will report their first results in 2017. The teams leading these observational studies, together with investigators leading other studies worldwide, have established the Microbleeds International Collaborative Network. We aim to undertake high quality large-scale pooled analyses that are free from biases such as selective inclusion and outcome reporting. With these aims in mind, our first project is a systematic review and individual patient data meta-analysis of the clinical relevance of cerebral microbleeds in patients with transient ischaemic attack and ischaemic stroke (the prospectively registered protocol is published online). This project will be done in accordance with the PRISMA-IPD standards for reporting systematic reviews and individual patient data meta-analyses. In May, 2016, we held a successful workshop at the European Stroke Organisation Conference in Barcelona, Spain, with input from 16 groups from 14 countries, in which investigators worked to finalise the protocol and set timelines. After this workshop, our Microbleeds International Collaborative Network team now has access to data from more than 10 000 individuals (table); we warmly welcome other investigators to contribute to expanding this research effort.TablePatient cohorts in the Microbleeds International Collaborative Network pooled analysis of cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack listed by study or cohort names and principle investigatorCountry of main study centreApproximate patient numberPatient populationApproximate % given oral anticoagulantsCROMIS-2, WerringUK1500Ischaemic stroke/transient ischaemic attack100%HERO, Martí-FàbregasSpain and Italy1000Ischaemic stroke/transient ischaemic attack100%ThijsBelgium481Ischaemic stroke/transient ischaemic attack25%SAMURAI-NVAF, SatoJapan1100Ischaemic stroke/transient ischaemic attack95%IPAAC, SooHong Kong500All atrial fibrillation; 60% with Ischaemic stroke/transient ischaemic attack100%Veltkamp and HorstmannGermany600Ischaemic stroke20%OrkenTurkey204Ischaemic stroke/transient ischaemic attack100%FazekasAustria624Ischaemic stroke/transient ischaemic attack20%FluriGermany75Ischaemic stroke/transient ischaemic attack20%FluriSwitzerland176transient ischaemic attack15%MICRO, KwaNetherlands397Ischaemic stroke10%TABASCO, BornsteinIsrael600Ischaemic stroke20%BIOSTROKE/TIA, KellyIreland289Ischaemic stroke/transient ischaemic attack25%AyUSA1000Ischaemic stroke20%ASTRAL, MichelSwitzerland800Ischaemic stroke20%NOACISP, EngelterSwitzerland500Ischaemic stroke/transient ischaemic attack100%HAGAKURE, YakushijiJapan280Ischaemic stroke/transient ischaemic attack30%CATCH, Smith and CouttsCanada431Ischaemic stroke/transient ischaemic attack10–20%Total number10381 Open table in a new tab Further work is also needed to standardise acquisition sequences, lesion definition and measurement, and post-processing of neuroimaging markers of small vessel disease. Members of the Microbleeds International Collaborative Network thus work closely with large-scale international harmonisation initiatives, including STRIVE5Wardlaw JM Smith EE Biessels GJ et al.Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration.Lancet Neurol. 2013; 12: 822-838Summary Full Text Full Text PDF PubMed Scopus (2966) Google Scholar and COEN.6De Guio F Jouvent E Biessels GJ et al.Reproducibility and variability of quantitative magnetic resonance imaging markers in cerebral small vessel disease.J Cereb Blood Flow Metab. 2016; 36: 1319-1337Crossref PubMed Scopus (69) Google Scholar Large-scale collaborative systematic reviews and pooled analyses will provide the evidence needed to impact clinical practice, including precise estimates of the risks associated with antithrombotic (antiplatelet and anticoagulant) drug exposure in patients with cerebral microbleeds. The Microbleeds International Collaborative Network endorses the need for global collaboration on cerebral microbleeds and small vessel disease research more widely; full, open communication and collaboration are essential to avoid duplication of effort. We look forward to working with other researchers worldwide to tackle the many outstanding research questions relating to cerebral microbleeds. This online publication has been corrected. The corrected version first appeared at thelancet.com/specialty on November 7, 2016 This online publication has been corrected. The corrected version first appeared at thelancet.com/specialty on November 7, 2016 The Stroke Association and British Heart Foundation fund the CROMIS-2 study including providing support for the Microbleed International Collaborative Network. The NOACISP registry is supported by a grant from the Swiss Heart Foundation. The HERO study received funding from Fondo de Investigaciones Sanitarias (PI11/00296), RETICS INVICTUS (RD012/0014/0002 and FEDER (Fondo Europeo de Desarrollo Regional). SAMURAI-NVAF was supported in part by a Grant-in-Aid (H23-Junkanki-Ippan-010) from the Ministry of Health, Labour and Welfare, Japan. The HAGAKURE study was supported by a Grant-in-Aid for Scientific Research (C), JSPS KAKENHI (Grant Number 15k10364). The IPAAC study is partially funded by a Hong Kong HMRF (Health and Medical Research Grant). Download .pdf (.09 MB) Help with pdf files Supplementary appendix A call for researchers to join the META-MICROBLEEDS ConsortiumDuring the last decade, cerebral microbleeds, a common neuroimaging finding in patients with cerebral small-vessel disease, have gained enormous importance in cerebrovascular research and clinical practice, reflected by the exponential rise in the number of publications on this subject.1 Detection of microbleeds in patients with stroke, in people with cognitive complaints, and in healthy elderly individuals creates many clinical dilemmas, especially regarding the future risk of ischaemic versus haemorrhagic stroke, and the safety of antithrombotic drug use. Full-Text PDF CorrectionsMicrobleeds International Collaborative Network. Worldwide collaboration in the Microbleeds International Collaborative Network. Lancet Neurol 2016; 15: 1113–14—In this Letter, E Auriel and N M Bornstein should not have appeared in the author list in the appendix and the affiliation for Sato S was incorrect. The author list has been corrected as of Oct 10, 2016. Full-Text PDF CorrectionsMicrobleeds International Collaborative Network. Worldwide collaboration in the Microbleeds International Collaborative Network. Lancet Neurol 2016; 15: 1113–14—In the table in this Letter, the HAGAKURE study was misspelt. This correction has been made to the online version as of Nov 7, 2016. Full-Text PDF
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