How do you counsel patients who develop DVT or atrial fibrillation requiring anticoagulation when being treated with lecanemab or donanemab?
I do not think that anticoagulation is contraindicated in patients with these Alzheimer's disease antibodies, but I would want to check APOE status. I would not initiate the AD treatment if the patient is E4E4, and even one E4 would make me hesitant to have a patient on anticoagulation and an Alzhei...
I believe until further data/studies are available, I would prefer not to use anticoagulation (at least long term) without comprehensive discussion among other treating physicians depending on the indication. The lecanemab appropriate use recommendations (Cummings et al., PMID 37357276) recommend ag...
I would do an MRI and APOE testing. If more than 2-3 microbleeds or other evidence of CAA, or APOE4, I would not treat with lecanemab, and certainly not with lecanemab and anticoagulation.