Fusco L, Palamà Z, Scarà A, Borrelli A, Robles AG, De Masi De Luca G, Romano S, Sciarra L. Management of cerebral amyloid angiopathy and atrial fibrillation: We are still far from precision medicine. World J Cardiol 2024; 16(5): 231-239 [PMID: 38817646 DOI: 10.4330/wjc.v16.i5.231]
Corresponding Author of This Article
Zefferino Palamà, MD, Research Fellow, Department of Cardiology, Casa di Cura Villa Verde, Taranto 70124, Italy. zefferino.palama@icloud.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. May 26, 2024; 16(5): 231-239 Published online May 26, 2024. doi: 10.4330/wjc.v16.i5.231
Management of cerebral amyloid angiopathy and atrial fibrillation: We are still far from precision medicine
Liuba Fusco, Zefferino Palamà, Antonio Scarà, Alessio Borrelli, Antonio Gianluca Robles, Gabriele De Masi De Luca, Silvio Romano, Luigi Sciarra
Liuba Fusco, Department of Cardiology, University Hospital of Northamptonshire, Northampton NN1 5BD, United Kingdom
Zefferino Palamà, Department of Cardiology, Casa di Cura Villa Verde, Taranto 70124, Italy
Zefferino Palamà, Antonio Gianluca Robles, Gabriele De Masi De Luca, Silvio Romano, Luigi Sciarra, Department of Life, Health and Environmental Sciences, University of l'Aquila, L'Aquila 67100, Italy
Antonio Scarà, Alessio Borrelli, Department of Cardiology, GVM Care and Research, San Carlo di Nancy Hospital, Rome 00100, Italy
Author contributions: Fusco L, Palamà Z, Scarà A, Borrelli A, Robles AG and De Masi De Luca G analyzed the data, wrote the manuscript; Romano S and Sciarra L revised the text. All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zefferino Palamà, MD, Research Fellow, Department of Cardiology, Casa di Cura Villa Verde, Taranto 70124, Italy. zefferino.palama@icloud.com
Received: November 18, 2023 Revised: January 29, 2024 Accepted: April 9, 2024 Published online: May 26, 2024 Processing time: 186 Days and 18.6 Hours
Abstract
The use of anticoagulation therapy could prove to be controversial when trying to balance ischemic stroke and intracranial bleeding risks in patients with concurrent cerebral amyloid angiopathy (CAA) and atrial fibrillation (AF). In fact, CAA is an age-related cerebral vasculopathy that predisposes patients to intracerebral hemorrhage. Nevertheless, many AF patients require oral systemic dose-adjusted warfarin, direct oral anticoagulants (such as factor Xa inhibitors) or direct thrombin inhibitors to control often associated with cardioembolic stroke risk. The prevalence of both CAA and AF is expected to rise, due to the aging of the population. This clinical dilemma is becoming increasingly common. In patients with coexisting AF and CAA, the risks/benefits profile of anticoagulant therapy must be assessed for each patient individually due to the lack of a clear-cut consensus with regard to its risks in scientific literature. This review aims to provide an overview of the management of patients with concomitant AF and CAA and proposes the implementation of a risk-based decision-making algorithm.
Core Tip: The use of anticoagulation therapy could prove to be controversial when trying to balance ischemic stroke and intracranial bleeding risks in patients with concurrent cerebral amyloid angiopathy (CAA) and atrial fibrillation (AF). This review aims to provide an overview of the management of patients with concomitant AF and CAA and proposes the implementation of a risk-based decision-making algorithm.
