Management of Oral Anti-Thrombotic Agents Associated Intracerebral Hemorrhage

Oral anti-thrombotic agents including anti-coagulants or anti-platelet agents are widely used to prevent cerebral infarction in patients with certain risk factors for ischemic stroke. Oral anti-coagulants, particularly warfarin, have long been used after Stroke Prevention in Atrial Fibrillation (SPAF) trials and European Atrial Fibrillation Trial proved its preventive effect. But along with the increased use of oral anti-thrombotic agents, the incidence of oral anti-thrombotic agent-associated intracranial hemorrhage has also increased. In many clinical trials, the recently approved oral anti-coagulants had a lower risk of hemorrhagic complication compared to warfarin, and real world evidence showed that non-vitamin K antagonist oral anti-coagulants have a relatively lower risk of hemorrhagic complication, especially intracerebral hemorrhage. However, the clinical outcome of non-vitamin K antagonist oral anti-coagulant-related intracerebral hemorrhage seems to be unfavorable. Moreover, management and prognosis of anti-platelet agent-associated intracerebral hemorrhage have been limited. The aim of this article is to review the currently suggested clinical evidences for 1. incidence and prognosis, 2. risk factors, 3. treatment, 4. resumption of anti-thrombotics in oral anti-thrombotic agent-associated intracerebral hemorrhage.