Abstract
We read with interest Mark Fisher’s review paper highlighting the very difficult decision-making many stroke physicians and neurologists are facing around the world on chronic anticoagulation for atrial fibrillation (AF) (1). As the author points out, oral anticoagulants are underutilized, often based on erroneous clinical reasoning, which may over-estimate bleeding risks. Part of the problem is that current clinical scoring systems for bleeding risk (e.g., HEMORR2HAGES, ATRIA, and HAS-BLED) might be of limited value in everyday clinical practice, especially in regard to intracerebral hemorrhage (ICH), the most feared and devastating complication of anticoagulation (2). The development of advanced brain MR imaging provides unique promise to tailor individual treatment decisions on anticoagulation by better balancing ICH and ischemic stroke risks (2). New radiological markers of cerebral small vessel disease (including cerebral microbleeds, cortical superficial siderosis, and white matter changes, etc.) have the potential to provide information about the presence of a hemorrhage-prone microangiopathy, which seems to underlie anticoagulation-related ICH (3–5).
Highlights
We read with interest Mark Fisher’s review paper highlighting the very difficult decision-making many stroke physicians and neurologists are facing around the world on chronic anticoagulation for atrial fibrillation (AF) [1]
We applaud the author’s new algorithm incorporating cerebral microbleeds on blood-sensitive MRI sequences [1]; before this approach can be recommended in clinical practice some potential limitations should be considered
The largest prospective study on CMBs and stroke risk after ischemic stroke to date included an Eastern (Asian) population, and the vast majority (93.4%) of patients with subsequent intracerebral hemorrhage (ICH) had deep CMBs likely reflecting the high prevalence of hypertensive arteriopathy, with a low prevalence of cerebral amyloid angiopathy in this cohort
Summary
We read with interest Mark Fisher’s review paper highlighting the very difficult decision-making many stroke physicians and neurologists are facing around the world on chronic anticoagulation for atrial fibrillation (AF) [1]. We applaud the author’s new algorithm incorporating cerebral microbleeds on blood-sensitive MRI sequences [1]; before this approach can be recommended in clinical practice some potential limitations should be considered. The data used to support the new algorithm come from a heterogeneous group of AF or stroke patients from very different study designs.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
