Key result
OAC resumption after index ICH averages ~31 days.
Why the study?
The optimal timing of resuming oral anticoagulants in patients with intracerebral hemorrhage remains a clinical dilemma.
Meta-Analysis
Effect estimate: Pooled mean 31 days (95% CI 13.7-48.3)
p-value: p=≈0
Based on a pooled analysis of 13 studies, the average time to resume oral anticoagulants in patients following an intracranial hemorrhage is approximately 31 days, though clinical practice varies significantly.
BACKGROUND AND OBJECTIVES: Intracerebral hemorrhage (ICH) is one of the most disabling cerebrovascular events. Several studies have discussed oral anticoagulant (OAC)-related ICH; however, the optimal timing of resuming OAC in patients with ICH is still a dilemma. In this literature review/meta-analysis, we will summarize, discuss, and provide the results of studies pertaining to OAC resumption in patients with ICH. METHODS: Using PubMed, Ovid Medline, and Web science, a systemic literature review was performed in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses statement on December 20, 2022. Inclusion criteria for the meta-analysis were all studies reporting mean, median, and standard deviation for the duration of anticoagulants resumption after ICH. Thirteen studies met the above criteria and were included in the meta-analysis. RESULTS: Of the 271 articles found in the literature, pooled analysis was performed in 13 studies that included timing of OAC resumption after ICH. The pooled mean duration to OAC resumption after the index ICH was 31 days (95% CI: 13.7-48.3). There was significant variation among the mean duration to OAC resumption reported by the studies as observed in the heterogeneity test ( P -value ≈0). CONCLUSION: Based on our meta-analysis, the average time of resuming OAC in patients with ICH is around 30 days. Several factors including the type of intracranial hemorrhage, the type of OAC, and the indication for OACs should be taken into consideration for future studies to try and identify the best time to resume OAC in patients with ICH.
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Naamani et al. (2023) conducted a meta-analysis in Intracerebral hemorrhage (ICH). Oral anticoagulant resumption was evaluated on Mean duration to OAC resumption after the index ICH (Pooled mean 31 days, 95% CI 13.7-48.3, p=≈0). The pooled mean duration to oral anticoagulant resumption after an index intracerebral hemorrhage across 13 studies was 31 days (95% CI 13.7-48.3).
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