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Int J Stroke. 2018 Feb;13(2):117-120. doi: 10.1177/1747493017741384. Epub 2017 Nov 9.

Cerebral amyloid angiopathy, cerebral microbleeds and implications for anticoagulation decisions: The need for a balanced approach.

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1 Department of Neurology, Hemorrhagic Stroke Research Group, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.
2 Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
3 Department of Medicine (Neurology), Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
4 Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
5 Univ. Lille, Inserm, CHU Lille, Degenerative & Vascular Cognitive Disorders, Lille, France.
6 Monash University, Melbourne, Australia.
7 Department of Neurology, Neurosciences Intensive Care Unit, Yale School of Medicine & Yale New Haven Hospital, New Haven, CT, USA.
8 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
9 Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA, USA.


Cerebral amyloid angiopathy is a common hemorrhagic small vessel disease of the brain, often associated with high risk of spontaneous lobar intracerebral hemorrhage. When the suspicion of cerebral amyloid angiopathy is raised, clinicians are hesitant in prescribing oral anticoagulation in patients in whom it is otherwise indicated, including the case of non-valvular atrial fibrillation. This is one of the thorniest clinical dilemmas in the field currently. In this short Leading Opinion piece by an international panel of clinicians-researchers active in the field, we present our consistent approach and future outlook on oral anticoagulation post intracerebral hemorrhage and in the setting of clinical-radiologic evidence of cerebral amyloid angiopathy. We discuss recent advances and support a more balanced approach with implications for the wider neurological clinical community in regards to successful recruiting this patient population in ongoing and future randomized trials.


Antithrombotic; MRI; brain microbleeds; cerebral amyloid angiopathy; cerebral hemorrhage; leukoaraiosis

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