Cited by 52Atrial Fibrillation Management and OutcomesIntracerebral and Subarachnoid Hemorrhage ResearchAcute Ischemic Stroke Management

Should oral anticoagulants be restarted after warfarin-associated cerebral haemorrhage in patients with atrial fibrillation?

Agnelli, Giancarlo, Paciaroni, Maurizio·2014·Thrombosis and Haemostasis

Abstract

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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Crossref · 10.1160/th13-08-0667

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  • No prospective studies have investigated the benefit or risk of initiation of oral anticoagulation after intracranial haemorrhage, and patients with a history of intracranial bleeding were excluded from randomized trials comparing NOACs with VKAs.

    “No prospective studies have investigated the benefit or risk of the initiation of OAC after intracranial haemorrhage, 483 and patients with a history of intracranial bleeding were excluded from the randomized trials comparing NOACs with VKAs.”

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Authors
Agnelli, G., & Paciaroni, M.
Affiliations
University of Perugia (IT)
Corresponding author
Paciaroni, Maurizio
Venue
Thrombosis and Haemostasis
Published
2014
Volume
111
Issue
01
Pages
14-18
ISSN
  • 0340-6245 (ISSN-L)
  • 2567-689X
OpenAlex
W2029248664
Cited by
52
References
39
Citations by year
2026: 1 · 2023: 2 · 2021: 4 · 2020: 4 · 2019: 1 · 2018: 6 · 2017: 8 · 2016: 11 · 2015: 9 · 2014: 6
FWCI
5.92
Type
journal article
Language
en
Open access
closed
Locations
  • Thrombosis and Haemostasis (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Neurology › Intracerebral and Subarachnoid Hemorrhage Research
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Keywords
oral anticoagulation, warfarin, cerebral hemorrhage, intracranial hemorrhage, atrial fibrillation, thromboembolic risk, cerebral amyloid angiopathy, lobar hemorrhage, CHA2DS2-VASc score, CHADS2 score, magnetic resonance imaging, risk-benefit assessment
MeSH terms
Administration, Oral, Aged, Anticoagulants, Atrial Fibrillation, Brain, Cerebrovascular Circulation, Female, Humans, Magnetic Resonance Imaging, Male, Microcirculation, Middle Aged, Recurrence, Risk, Thromboembolism, Warfarin, Intracranial Hemorrhages, Stroke

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