New horizons: managing antithrombotic dilemmas in patients with cerebral amyloid angiopathy

Abstract Cerebral amyloid angiopathy (CAA) most commonly presents with lobar intracerebral haemorrhage, though also transient focal neurological episodes, cognitive impairment, as an incidental finding and rarely acutely or subacutely in patients developing immune response to amyloid. Convexity subarachnoid cortical superficial siderosis cerebral microbleeds are the other signature imaging features. The main implications of a diagnosis risk haemorrhage frequent co-existence antithrombotic indications. varies by phenotype, being highest episodes lowest isolated microbleeds. There is only one relevant randomised controlled trial CAA indications: RESTART showed that presenting while taking antiplatelets, restarting treatment appeared reduce recurrent improve outcomes. Observational indirect data reviewed scenarios where there In microbleed-only ischaemic stroke exceeds at all microbleed burdens. atrial fibrillation (AF), left appendage occlusion, device closure excludes from circulation, can be considered anticoagulation seems prohibitive. Ongoing trials testing role direct oral anticoagulant (DOACs) occlusion haemorrhage/AF but interim, decisions will need individualised remain difficult.