Does the presence and location of cerebral microbleeds affect your decision for antithrombotic treatment in patients with atrial fibrillation?
Do you distinguish between primary and secondary prevention? Wilson et al., PMID 31130428 is helpful, but curious how people apply this data in practice.
Answer from: at Community Practice
That is a great question. Agree, the data is observational and no firm conclusions can be made. My practice is to consider left atrial appendage occlusion in patients with suspected CAA. In patients with hypertensive microbleeds, both resuming anticoagulation and left atrial appendage occlusion are ...
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Answer from: at Academic Institution
As Dr. @Shadi Yaghi already said, even the large meta-analysis by Wilson et al., PMID 31130428 is based on observational data. Thus it is difficult to make hard, all-encompassing recommendations based on it. To make matters more complicated, emerging evidence suggests that although deep CMBs/IC...
Answer from: at Academic Institution
I would avoid anticoagulation in the presence of more than 10 microbleeds and would seek an electrophysiology solution or ligation of the atrial appendage with WATCHMAN.