Key result
A heart-brain team approach with shared decision making is proposed to manage stroke and bleeding risks in atrial fibrillation patients with cerebral amyloid angiopathy.
Why the study?
Cerebral amyloid angiopathy increases intracerebral bleeding risk with anticoagulation in elderly patients with atrial fibrillation, yet it is absent from current risk-benefit models and lacks randomized trial data to guide management.
Answers are grounded in this paper and cite their sources.
This review highlights the importance of a heart-brain team approach and shared decision-making for managing stroke risk and anticoagulation in elderly atrial fibrillation patients with cerebral amyloid angiopathy, given its absence from current bleeding risk models.
With an aging population, clinicians are more frequently encountering patients with atrial fibrillation who are also at risk of intracerebral hemorrhage due to cerebral amyloid angiopathy, the result of β-amyloid deposition in cerebral vessels. Cerebral amyloid angiopathy is common among elderly patients, and is associated with an increased risk of intracerebral bleeding, especially with the use of anticoagulation. Despite this association, this entity is absent in current risk-benefit analysis models, which may result in underestimation of the chance of bleeding in the subset of patients with this disease. Determining the presence and burden of cerebral amyloid angiopathy is particularly important when planning to start or restart anticoagulation after an intracerebral hemorrhage. Given the lack of randomized trial data to guide management strategies, we discuss a heart-brain team approach that includes clinician-patient shared decision making for the use of pharmacologic and nonpharmacologic approaches to diminish stroke risk.
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DeSimone et al. (2017) conducted a review in Atrial fibrillation and cerebral amyloid angiopathy. Heart-brain team approach and shared decision making for anticoagulation and stroke risk reduction was evaluated. A heart-brain team approach with shared decision making is proposed to manage stroke and bleeding risks in atrial fibrillation patients with cerebral amyloid angiopathy.
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