DOACs offer a lower risk of intracranial bleeding compared to warfarin in patients with atrial fibrillation, though resuming anticoagulation after a hemorrhage requires individualized risk-benefit assessment.
Supports DOAC preference to lower intracranial bleed risk in AF; leaves resumption after hemorrhage open to individualized assessment.
Patients with atrial fibrillation have an increased risk of ischemic stroke that can be dramatically lowered by treatment with anticoagulants. The annual rate of major bleeds with warfarin averages about 2%. The rates of intracerebral and intracranial bleeds are significantly reduced with the use of the novel direct oral anticoagulants (DOACs) compared with warfarin. Treatment of anticoagulation-related intracerebral hemorrhage is based on the results of case series and small trials. Resumption of anticoagulation in patients with atrial fibrillation who had an intracerebral bleed depends on the etiology and location of the bleeding and the absolute rate of stroke in the absence of anticoagulation.
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Diener et al. (2014) studied this question.
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