Three checks shape the risk of ARIA. APOE4 testing is recommended before starting, because homozygotes carry the highest risk. A recent baseline MRI is needed to count microbleeds and exclude superficial siderosis or other contraindications. And anticoagulant use should be reviewed, because haemorrhage on anticoagulation is a recognised concern and thrombolysis decisions become harder during treatment.
- Offer APOE4 genotyping and discuss the result before starting.
- Obtain a recent baseline MRI with susceptibility-weighted imaging.
- Review anticoagulant use and document a plan for acute stroke during treatment.
- Repeat MRI at the monitoring points set out in the product label.
Why it matters
Most serious ARIA is predictable from information available before the first dose.
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