Key result
Restarting oral anticoagulants after warfarin-associated cerebral hemorrhage may provide net benefit in patients with deep hemispheric ICH and a baseline ischemic stroke risk >6.5% per year.
Why the study?
Does resuming oral anticoagulation improve outcomes in patients with atrial fibrillation after warfarin-associated cerebral haemorrhage?
Does resuming oral anticoagulation improve outcomes in patients with atrial fibrillation after warfarin-associated cerebral haemorrhage?
Restarting oral anticoagulation after warfarin-associated ICH in AF patients may be beneficial for those with deep hemispheric ICH and high stroke risk, but should be avoided in lobar haemorrhage.
May support individualized OAC decisions in deep hemispheric ICH; leaves open randomized confirmation in AF.
Intracranial haemorrhage (ICH), which affects up to 1% of patients on oral anticoagulation per year, is the most feared and devastating complication of this treatment. After such an event, it is unclear whether anticoagulant therapy should be resumed. Such a decision hinges upon the assessment of the competing risks of haematoma growth or recurrent ICH and thromboembolic events. ICH location and the risk for ischaemic cerebrovascular event seem to be the key factors that lead to risk/benefit balance of restarting anticoagulation after ICH. Patients with lobar haemorrhage or cerebral amyloid angiopathy remain at higher risk for anticoagulant-related ICH recurrence than thromboembolic events and, therefore would be best managed without anticoagulants. Patients with deep hemispheric ICH and a baseline risk of ischemic stroke >6.5% per year, that corresponds to CHADS2≥ 4 or CHA2DS2-VASc ≥ 5, may receive net benefit from restarting anticoagulation. To date, a reasonable recommendation regarding time to resumption of anticoagulation therapy would be after 10 weeks. Available data regarding the role of magnetic resonance imaging in assessing the risks of both ICH and warfarin-related ICH do not support the use of this test for excluding anticoagulation in patients with atrial fibrillation.
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Agnelli et al. (2013) conducted a review in Atrial fibrillation with warfarin-associated cerebral haemorrhage. Restarting oral anticoagulants vs. Without anticoagulants was evaluated. Restarting oral anticoagulants after warfarin-associated cerebral hemorrhage may provide net benefit in patients with deep hemispheric ICH and a baseline ischemic stroke risk >6.5% per year.
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