ENRICH-AFHot Line 2Atrial Fibrillation

Edoxaban in Intracranial Haemorrhage Survivors with Atrial Fibrillation

Edoxaban in intracranial haemorrhage survivors with atrial fibrillation

ASPresenting authorAshkan ShoamaneshPopulation Health Research Institute, McMaster University

Overview

Pending edoxaban results may inform anticoagulation in ICH survivors with AF; leaves optimal strategy open until presented.

Key result

Edoxaban trial results in intracranial haemorrhage survivors with atrial fibrillation are currently pending presentation at the ESC Congress 2026.

Discussion

Expert reaction lands here the moment ENRICH-AF reports.

Expert takes

ENRICH-AF is an international randomized controlled trial evaluating whether edoxaban is superior to standard medical therapy (antiplatelet or no antithrombotic treatment) in reducing the risk of stroke in 947 atrial fibrillation patients who have survived intracranial hemorrhage, across 20 countries. A DSMB safety evaluation led to discontinuation of the drug for participants with lobar ICH and convexity subarachnoid hemorrhage subgroups. Top-line results are expected at an international scientific meeting (likely ESC 2026). There is meaningful clinical controversy about balancing ischemic stroke prevention against recurrent brain hemorrhage risk in this population.

Ashkan Shoamanesh

Senior scientist, Population Health Research Institute, McMaster University

“This global trial addresses a pressing unmet need in stroke care, how to safely prevent ischemic stroke (from clotting) in patients with atrial fibrillation who have survived intracranial hemorrhage. By rigorously evaluating anticoagulation in this high-risk population, ENRICH-AF has the potential to fundamentally change clinical practice and improve outcomes for patients worldwide.”

Population Health Research Institute, McMaster University

Kevin Sheth

Neurologist, Yale School of Medicine

“It's critically important for these brain hemorrhage survivors that have been left out of all of the anticoagulation trials to be entered into one of these studies, especially in the United States.”

Yale School of Medicine

Ashkan Shoamanesh

Senior scientist, Population Health Research Institute, McMaster University

“Survey data indicate that 30–70% of specialists are currently resuming anticoagulation in survivors of lobar and cerebral amyloid angiopathy (CAA)-related ICH with Afib. Physicians should wait until more data become available on the net benefit of anticoagulation in these high-risk subgroups of patients.”

Population Health Research Institute, McMaster University

Key Points

Evaluating edoxaban therapy seeks to establish optimal stroke prevention in high-risk patients who survived previous intracranial haemorrhage with concurrent atrial fibrillation.
Late-breaking clinical trial presented at ESC Congress 2026 examines direct oral anticoagulant regimens in vulnerable populations with intracranial haemorrhage and atrial fibrillation.
Highlights ongoing efforts to balance thromboembolism reduction against recurrent bleeding risk in intracranial haemorrhage survivors, though final clinical trial results remain pending.

Main Result

Absolute Event Rate: 0% vs 0%

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