Anticoagulation Resumption After Intracerebral Hemorrhage

Current Atherosclerosis Reports
Yan-Guang Li, Gregory Y H Lip

Abstract

Decision-making on resuming oral anticoagulant (OAC) after intracerebral hemorrhage (ICH) evokes significant debate among clinicians. Such patients have been excluded from randomized clinical trials. This review article provides a comprehensive summary of the evidence on anticoagulation resumption after ICH. OAC resumption does not increase the risk of recurrent ICH and can also reduce the risk of all-cause mortality. OAC cessation exposes patients to a significantly higher risk of thromboembolism, which could be reduced by resumption. The optimal timing of anticoagulation resumption after ICH is still unknown. Both early (< 2 weeks) and late (> 4 weeks) resumption should be reached only after very careful assessment of risks for ICH recurrence and thromboembolism. The introduction of new oral anticoagulants and other interventions, such as left atrial appendage closure, has provided some patients with more alternatives. Given the lack of high-quality evidence to guide clinical decision-making, clinicians must carefully balance the risks of thromboembolism and recurrent ICH in individual patients. We propose a management approach which would facilitate the decision-making process on whether anticoagulation is appropriate, as we...Continue Reading

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Citations

Jul 25, 2019·Expert Review of Hematology·Monika KoziełGregory Y H Lip
Dec 5, 2019·The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques·Andrea WanTammy J Bungard
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Apr 15, 2021·Seminars in Neurology·Ibrahim MigdadyAndrew B Buletko
Sep 21, 2021·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Carla Seabra AbrantesPaulo Castro Chaves
Jan 29, 2021·Case Reports in Neurology·Tsong-Hai Lee

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