Atrial Fibrillation and Microbleeds

A trial fibrillation (AF) is a common cause of cardioem- bolism and ischemic stroke (IS).Long-term oral anticoagulation (OAC) is the mainstay therapy for IS prevention in patients with AF.However, uncertainties exist about the safety of OAC in AF patients with coexisting cerebral microbleeds (CMBs).Several studies suggest that individuals with CMBs seem to be at increased risk for future stroke, in particular intracerebral hemorrhage (ICH).[1][2][3][4] Also, the presence and number of CMBs seem to correlate with CHADS 2 and CHADS 2 -VASC scores (congestive heart failure/left ventricular systolic dysfunction, hypertension, age ≥75 years, diabetes mellitus, stroke or TIA or thromboembolism, vascular disease), which are used to estimate IS risk in patients with AF. 5,6 As a result, the detection of CMBs often raises the following host of questions and leads to a therapeutic dilemma.1. Does the detection of CMBs in patients with AF imply high risk for ICH to offset any benefit from OAC? 2. Are predictive scales for the risk of bleeding or IS in patients with AF useful to stratify the risk/benefit and to aid with decision-making? 3. Does the burden and anatomic location of CMBs influence risks for future ICH?We will address these questions in this review and attempt to provide a pragmatic approach to the treatment of AF in patients with CMBs.