Haußmann R, Homeyer P, Haußmann M, Brandt M, Donix M, Puetz V, Linn J
Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
Universitäts DemenzCentrum (UDC), Klinik und Poliklinik für Psychiatrie und Psychotherapie, Uniklinikum Dresden, Dresden, Deutschland.
Nervenarzt. 2022 Jun;93(6):599-604. doi: 10.1007/s00115-021-01206-w. Epub 2021 Oct 15.
Oral anticoagulation in patients with cerebral amyloid angiopathy is a therapeutic challenge. The association of cerebral amyloid angiopathy with intracerebral hemorrhage, a high mortality of intracerebral hemorrhage especially under oral anticoagulation and the high risk of recurrent bleeding require a multidisciplinary approach and a thorough risk-benefit analysis. Vitamin K antagonists increase the risk of intracerebral bleeding and the accompanying mortality by 60% and should be avoided if possible or reserved for special clinical situations (e.g. mechanical aortic valve replacement). Treatment with novel oral anticoagulants and antiplatelet drugs also increases the risk of cerebral bleeding and therefore needs a thorough risk-benefit evaluation. An interventional left atrial appendage closure is a promising therapeutic option especially in patients with an absolute arrythmia with atrial fibrillation. Furthermore, other clinical implications in patients with cerebral amyloid angiopathy are the subject of this review of the literature, such as special characteristics after acute ischemic stroke and the necessary secondary prophylaxis, with previous intracerebral hemorrhage and in patients with cognitive deficits.
脑淀粉样血管病患者的口服抗凝治疗是一项治疗挑战。脑淀粉样血管病与脑出血相关，脑出血死亡率高，尤其是在口服抗凝治疗期间，且复发性出血风险高，这需要多学科方法和全面的风险效益分析。维生素K拮抗剂会使脑出血风险及随之而来的死亡率增加60%，应尽可能避免使用，或仅用于特殊临床情况（如机械主动脉瓣置换）。新型口服抗凝药和抗血小板药物治疗也会增加脑出血风险，因此需要进行全面的风险效益评估。介入性左心耳封堵术是一种有前景的治疗选择，尤其适用于患有绝对心律失常伴房颤的患者。此外，脑淀粉样血管病患者的其他临床问题也是本文献综述的主题，如急性缺血性卒中后的特殊特征以及必要的二级预防，既往有脑出血的情况以及认知功能缺损患者。
