TY - JOUR
T1 - Cerebral Amyloid Angiopathy
T2 - Diagnosis, Clinical Implications, and Management Strategies in Atrial Fibrillation
AU - DeSimone, Christopher V.
AU - Graff-Radford, Jonathan
AU - El-Harasis, Majd A.
AU - Rabinstein, Alejandro A.
AU - Asirvatham, Samuel J.
AU - Holmes, David R.
N1 - Publisher Copyright:
© 2017 American College of Cardiology Foundation
PY - 2017/8/29
Y1 - 2017/8/29
N2 - 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.
AB - 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.
KW - Alzheimer's dementia
KW - atrial fibrillation
KW - cerebral amyloid angiopathy
KW - direct oral anticoagulant
KW - management
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UR - http://www.scopus.com/inward/citedby.url?scp=85028623689&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2017.07.724
DO - 10.1016/j.jacc.2017.07.724
M3 - Review article
C2 - 28838368
AN - SCOPUS:85028623689
SN - 0735-1097
VL - 70
SP - 1173
EP - 1182
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 9
ER -