With an aging population, clinicians are more frequently encountering patients with atrial fibrillation who are also at risk of intracerebral hemorrhage due to cerebral amyloid angiopathy, the result of β-amyloid deposition in cerebral vessels. Cerebral amyloid angiopathy is common among elderly patients, and is associated with an increased risk of intracerebral bleeding, especially with the use of anticoagulation. Despite this association, this entity is absent in current risk-benefit analysis models, which may result in underestimation of the chance of bleeding in the subset of patients with this disease. Determining the presence and burden of cerebral amyloid angiopathy is particularly important when planning to start or restart anticoagulation after an intracerebral hemorrhage. Given the lack of randomized trial data to guide management strategies, we discuss a heart-brain team approach that includes clinician-patient shared decision making for the use of pharmacologic and nonpharmacologic approaches to diminish stroke risk.

中文翻译：

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脑淀粉样血管病

随着人口老龄化，临床医生更频繁地遇到心房颤动患者，这些患者也因脑淀粉样血管病（β-淀粉样蛋白沉积在脑血管中的结果）而面临脑内出血的风险。脑淀粉样血管病在老年患者中很常见，并且与脑内出血的风险增加有关，尤其是在使用抗凝剂时。尽管存在这种关联，但当前的风险-收益分析模型中不存在该实体，这可能会导致低估该疾病患者子集的出血机会。当计划在脑出血后开始或重新开始抗凝治疗时，确定脑淀粉样血管病的存在和负担尤为重要。