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.
Int J Stroke. 2018 Feb;13(2):117-120. doi: 10.1177/1747493017741384. Epub 2017 Nov 9.
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.
脑淀粉样血管病是一种常见的脑出血性小血管疾病，常伴有自发性脑叶颅内出血的高风险。当怀疑脑淀粉样血管病时，临床医生会犹豫不决是否在其他情况下需要抗凝的患者中开口服抗凝药，包括非瓣膜性心房颤动患者。这是目前该领域最棘手的临床难题之一。在这篇由国际临床研究专家小组撰写的短评中，我们介绍了我们在脑出血后和有临床-影像学脑淀粉样血管病证据的情况下使用口服抗凝药的一致方法和未来展望。我们讨论了最近的进展，并支持更平衡的方法，这对更广泛的神经科临床社区在招募正在进行和未来的随机试验中的这一患者群体方面具有重要意义。
