Key result
LAAO offers a safer alternative to anticoagulation in cerebral amyloid angiopathy given high bleeding risks.
Why the study?
Cerebral amyloid angiopathy increases the risk of intracranial bleeding with oral anticoagulants and can mimic TIA or stroke, leading to potentially dangerous anticoagulant initiation if undiagnosed.
Recognizing and diagnosing cerebral amyloid angiopathy via MRI in elderly patients with atrial fibrillation is critical to preventing catastrophic intracranial bleeding caused by contraindicated oral anticoagulants.
Non-valvular atrial fibrillation (AF) and cerebral amyloid angiopathy (CAA) are two common diseases in elderly populations. Despite the effectiveness of oral anticoagulant therapy in cardioembolic stroke prevention, intracranial hemorrhage represents the most serious complication of these therapies. Cerebral amyloid angiopathy is one of the main risk factors for spontaneous intracranial bleeding, and this risk is highly increased by age and concomitant antithrombotic therapies. Cerebral amyloid angiopathy can be silent for years and then manifest with clinical features simulating TIA (TIA-mimics) or stroke in AF patients, pushing clinicians to rapidly start VKAs or DOACs, thus increasing the risk of intracranial bleeding if the diagnosis of CAA was unknown. Because the cerebral amyloid angiopathy is easily diagnosed with non-contrast MRI, suspecting the disease can avoid catastrophic complications. In this review, we will provide physicians managing anticoagulant therapies with key tips to familiarize themselves with cerebral amyloid angiopathy, with a focus on the possible clinical presentations and on the diagnostic criteria.
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Merella et al. (2023) conducted a review in Atrial Fibrillation and Cerebral Amyloid Angiopathy. Oral anticoagulant therapy was evaluated. Anticoagulants should generally be avoided in patients with cerebral amyloid angiopathy due to the high risk of recurrent hemorrhagic stroke, making left-atrial appendage occlusion a potential safe alternative.
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