Risk of amyloid-related imaging abnormalities associated with anticoagulant therapy in patients with Alzheimer’s disease treated with anti-amyloid monoclonal antibodies: a systematic review and meta-analysis

Anti-amyloid monoclonal antibodies have emerged as a disease-modifying treatment option in early Alzheimer’s disease (AD). In patients receiving anti-amyloid immunotherapy, Aβ removal-associated blood-brain barrier damage and perivascular inflammation may present as amyloid-related imaging abnormalities (ARIA) or intracerebral haemorrhage (ICH). Based on theoretical and empirical concerns that ARIA might be more common and more severe in patients receiving oral anticoagulants, current recommendations caution against the combination of oral anticoagulants and anti-amyloid antibodies. 1 2 In the European Union (EU) and UK, anti-amyloid antibody therapies are not authorised for patients receiving anticoagulants.