Key result
Re-initiation of prophylactic-dose anticoagulation after 24-72 hours, following acute reversal, is recommended for survivors of anticoagulant-associated intra-cerebral hemorrhage.
Why the study?
Should oral anticoagulants be re-initiated in survivors of hemorrhagic stroke?
Should oral anticoagulants be re-initiated in survivors of hemorrhagic stroke?
In survivors of anticoagulant-associated intracerebral hemorrhage, acute reversal followed by gradual reinstitution of prophylactic anticoagulation after 24-72 hours is recommended to balance thromboembolic and bleeding risks.
Supports re-initiation of prophylactic anticoagulation 24-72 h post-reversal in anticoagulant-associated ICH survivors; leaves open need for randomized confirmation.
Intra-cerebral hemorrhage (ICH) is the most feared and the deadliest complication of oral anticoagulant therapy, i.e. warfarin (Coumadin). After such an occurrence, clinicians wonder whether their patients should resume anticoagulant therapy. The decisions to reverse and re-initiate anticoagulation hinge on the phase of stroke as the risk of thromboembolism outweighs risk of bleeding in the chronic phase. Hence in the short term, most patients with ICH will benefit from acute reversal of anticoagulation, followed by gradual reinstitution of prophylactic-dose anticoagulation after first 24–72 h. The underlying cause of stroke should guide the long-term management.
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Renjen et al. (2017) conducted a review in Intra-cerebral hemorrhage (ICH) in patients on oral anticoagulant therapy. Re-initiation of oral anticoagulants was evaluated. Re-initiation of prophylactic-dose anticoagulation after 24-72 hours, following acute reversal, is recommended for survivors of anticoagulant-associated intra-cerebral hemorrhage.
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