[Risk of vitamin K antagonists in cases of cerebral microbleeds]

- Cerebral microbleeds are associated with a higher risk of intracerebral hemorrhage.- When microbleeds are detected, the possible underlying pathology should be considered; this includes cerebral amyloid angiopathy and other factors that increase the risk of haemorrhage, particularly hypertension. - No randomised trials have yet been conducted into haemorrhagic complications and cerebral infarctions in patients with microbleeds who take vitamin K antagonists. This means that it is not clear whether the intended prevention of cerebral infarctions outweighs the increased risk of haemorrhage associated with use of vitamin K antagonists by these patients.- When deciding whether or not an older patient should be given anticoagulants the following should be taken into consideration as well: comorbidities, polypharmacy, the risk of falls and the probability that the patient can be optimally titrated to vitamin K antagonists. - If there is an increased risk of intracerebral haemorrhage but anticoagulants are indicated, direct oral anticoagulants (DOACs) might be preferable to vitamin K antagonists in patients with a history of cerebral microbleeds.