How would you determine the safety of anticoagulation in patients with evidence of cerebral microhemorrhages who present with acute stroke secondary to cardioembolism?

This question assumes that the patient already had an MRI showing microhemorrhages. The Boston criteria provide guidelines for the number of microbleeds, associated superficial siderosis, or major hemorrhage to make the diagnosis of cerebral amyloid angiopathy. I would also assume that at least some...

There are observational data that suggest the relative safety of anticoagulation in patients with ischemic stroke or TIA with incidentally found cerebral microhemorrhages. An analysis of pooled data from multiple cohorts totaling 20,322 participants showed that recurrent symptomatic ischemic stroke ...

There is no definitive answer to the question of anticoagulation in patients with demonstrable microbleeds. Typically, the number of microbleeds is determined by MRI findings. My approach is to exercise caution regarding anticoagulation with more than 5 microbleeds. However, others may exercise caut...

I would only be hesitant about anticoagulation if the MRI looks highly suspicious for cerebral amyloid. In which case, I would evaluate for L atrial appendage closure. Otherwise, the benefits of anticoagulation outweigh the risks in nondescript microhemorrhages and the patient would simply need the ...