Stroke prevention in an octogenarian with atrial fibrillation, cerebral amyloid angiopathy and intracerebral hemorrhage

Abstract

Key Clinical Message Left‐atrial‐appendage‐closure (LAAC) is suggested as alternative to antiplatelet/anticoagulant therapy (AP/AC) for stroke‐prevention in patients with cerebral‐amyloid‐angiopathy (CAA), intracerebral hemorrhage (ICH) and atrial fibrillation (AF). Disadvantages of LAAC are the need for postinterventional AP and impairment of left atrial function, thus promoting heart‐failure. Therefore, in an 83‐year‐old edoxaban‐treated AF‐patient with ICH and CAA, only antihypertensive therapy with neither AP/AC nor LAAC was recommended. Twenty‐seven months without stroke/ICH support this strategy, which needs confirmation by a randomized‐trial.

Keywords

• anticoagulant therapy
• atrial fibrillation
• cerebral amyloid angiopathy
• cerebral bleeding
• left atrial appendage closure