After intracranial bleeding, DOACs in atrial fibrillation were linked to fewer strokes and deaths without more rebleeding

The edition in brief

A Finnish nationwide cohort of 1,502 people with atrial fibrillation and earlier intracranial bleeding found that, compared with no anticoagulation, DOAC use was associated with lower one-year risks of ischaemic stroke (0.7% vs 4.1%) and death (4.7% vs 14.7%) with no increase in intracranial bleeding; warfarin was associated with fewer strokes but more rebleeding. Over half received no anticoagulant. A meta-analysis of 37 real-world lecanemab studies found ARIA in 15% overall, 34% in APOE ε4 homozygotes and 11% in non-carriers, with symptomatic ARIA in 1.3%; without control groups, cognitive effects could not be judged. A Japanese claims cohort of 14,355 people with atrial fibrillation after ischaemic stroke found early rhythm control, used in only 1.9%, was associated with fewer recurrent strokes or emboli (HR 0.56); this is observational and needs a trial. A UK primary care study of almost four million antibiotic users found no excess peripheral neuropathy with fluoroquinolones compared with cephalosporins, while the expected tendon rupture signal appeared. The pearl covers checking vitamin B12 in new neuropathy.