Key result
OAC resumption reaches ~51% in AF survivors post-ICH, while LAAC remains rarely utilized.
Why the study?
Resumption of OAC after ICH carries significant haemorrhagic risk, making stroke prevention in AF challenging, while LAAC provides an alternative for anticoagulation-unsuitable patients.
Observational (n=100)
No
In patients with atrial fibrillation and recent intracerebral haemorrhage, left atrial appendage closure is underutilized in those deemed unsuitable for oral anticoagulation resumption.
Variable OAC practice after AF-ICH signals therapeutic uncertainty; leaves open LAAC role pending randomized evidence.
Background and aims Atrial fibrillation (AF) in the context of intracerebral haemorrhage (ICH) presents a major therapeutic challenge. Resumption of oral anticoagulation (OAC) after ICH carries a significant haemorrhagic risk. Left atrial appendage closure (LAAC) offers an alternative for patients considered unsuitable for anticoagulation. We aimed to evaluate post-ICH stroke prevention strategies in patients with AF, with focus on LAAC utilisation. Methods We conducted a retrospective observational single-centre study as part of a quality improvement project, using the UK national stroke registry and hospital electronic patient records. Patients admitted with ICH between January 2023 and October 2025 with pre-existing or newly diagnosed AF and an indication for anticoagulation were included. Inpatient outcomes, SMASH-U aetiology, anticoagulation decisions, timing of OAC resumption, follow-up neuroimaging, and referral for LAAC were analysed. Results 100 patients met inclusion criteria. Medication-related and hypertensive ICH accounted for 52% of cases, while cerebral amyloid angiopathy was identified in 3%. OAC was restarted in 51% of surviving patients, at a mean of 9.1 weeks following ICH. Among patients in whom OAC was not resumed due to high perceived bleeding risk (n=19), only two underwent LAAC. Documentation of risk stratification was inconsistent, with CHA₂DS₂-VASc and ORBIT scores calculated in 26% and 18% of patients, respectively. Conclusions Management of AF after ICH remains complex. LAAC was infrequently utilised in patients unsuitable for anticoagulation, leaving many exposed to ongoing embolic stroke risk. These findings highlight the need for structured risk stratification and streamlined referral pathways to support consistent, evidence-based post-ICH stroke prevention. Conflict of interest Kee Bum Kim-Nothing to Disclose.Maria Kurian George-Nothing to Disclose. Yuan Yuan Kheng-Nothing to Disclose. Akshitha Sunny-Nothing to Disclose. Ambreen Ali Sheikh-Nothing to Disclose. Adam Seed-Nothing to Disclose. THANT HLAING-Nothing to Disclose
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George et al. (2026) conducted an observational in Atrial fibrillation after intracerebral haemorrhage (n=100). Oral anticoagulation and Left atrial appendage closure was evaluated on Utilization of post-ICH stroke prevention strategies including OAC resumption and LAAC. Oral anticoagulation was restarted in 51% of survivors with atrial fibrillation after intracerebral haemorrhage, while left atrial appendage closure was utilized in only 2 of 19 high-risk patients.
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