March 19, 2024

Risk of Cerebral Hemorrhage with Lytics and Anti-Amyloid Drugs

Patients taking the new anti-amyloid monoclonal antibodies for dementia may experience neurologic adverse events from small volume bleeding, which may mimic stroke.

Currently lecanemab (Leqembi®) and aducanumab (Aduhelm) are the only anti-amyloid monoclonal antibodies on the market.

If a patient on one of these medications presents with significant headache, gait imbalance, seizures or other neurological signs or symptoms, they will need an MRI to rule out amyloid-related imaging abnormalities (ARIA).

CT and possibly even an older 0.5T MRI will not be adequate to evaluate for these edematous or hemorrhagic changes.

There is at least one case report of death following TPA/lytics on these medications because of multiple intracranial hemorrhages. Patients on these medications should have an MRI prior to lytics, if at all possible.

Consultation with the prescribing neurologist and shared decision-making with the family and patients are important.

For more information, the Geriatric Emergency Department Collaborative is hosting a free webinar from 3 to 4 pm EST, March 25. More details and registration is available online.


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