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Cerebral Amyloid Angiopathy: Diagnosis, Clinical Implications, and Management Strategies in Atrial Fibrillation.

Abstract 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.
PMID
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Authors

Mayor MeshTerms
Keywords

Alzheimer’s dementia

atrial fibrillation

cerebral amyloid angiopathy

direct oral anticoagulant

management

Journal Title journal of the american college of cardiology
Publication Year Start




PMID- 28838368
OWN - NLM
STAT- In-Process
DA  - 20170825
LR  - 20170825
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 70
IP  - 9
DP  - 2017 Aug 29
TI  - Cerebral Amyloid Angiopathy: Diagnosis, Clinical Implications, and Management
      Strategies in Atrial Fibrillation.
PG  - 1173-1182
LID - S0735-1097(17)38795-8 [pii]
LID - 10.1016/j.jacc.2017.07.724 [doi]
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 beta-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.
CI  - Copyright (c) 2017 American College of Cardiology Foundation. Published by
      Elsevier Inc. All rights reserved.
FAU - DeSimone, Christopher V
AU  - DeSimone CV
AD  - Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
FAU - Graff-Radford, Jonathan
AU  - Graff-Radford J
AD  - Department of Neurology, Mayo Clinic, Rochester, Minnesota.
FAU - El-Harasis, Majd A
AU  - El-Harasis MA
AD  - Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
FAU - Rabinstein, Alejandro A
AU  - Rabinstein AA
AD  - Department of Neurology, Mayo Clinic, Rochester, Minnesota.
FAU - Asirvatham, Samuel J
AU  - Asirvatham SJ
AD  - Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota;
      Division of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
FAU - Holmes, David R Jr
AU  - Holmes DR Jr
AD  - Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
      Electronic address: [email protected]
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
OTO - NOTNLM
OT  - Alzheimer's dementia
OT  - atrial fibrillation
OT  - cerebral amyloid angiopathy
OT  - direct oral anticoagulant
OT  - management
EDAT- 2017/08/26 06:00
MHDA- 2017/08/26 06:00
CRDT- 2017/08/26 06:00
PHST- 2017/05/26 [received]
PHST- 2017/07/14 [revised]
PHST- 2017/07/14 [accepted]
AID - S0735-1097(17)38795-8 [pii]
AID - 10.1016/j.jacc.2017.07.724 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2017 Aug 29;70(9):1173-1182. doi: 10.1016/j.jacc.2017.07.724.