BACKGROUND: We summarize the existing evidence on the potential benefit of oral anticoagulation (OAC) in intracerebral hemorrhage (ICH) survivors with nonvalvular atrial fibrillation (NVAF). METHODS: Systematic review of the literature to address the following issues: (1) prevalence of NVAF in ICH survivors, (2) current prescription of OAC, (3) factors associated with resumption of OAC, (4) risk of ischemic stroke (IS) and recurrent ICH, and (5) ideal timing for restarting OAC in ICH survivors with NVAF. RESULTS: After screening 547 articles, 26 were included in the review. Only 3 focused specifically on patients with ICH as primary event, NVAF as indication for OAC, and recurrent ICH and IS as primary endpoints. In addition, 19 letters to the editor/reviews/editorials/experts' surveys/experts' opinion were used for discussion purposes. CONCLUSIONS: NVAF is highly prevalent among ICH survivors. The risks of IS, recurrent ICH, and mortality are heightened in this group. Most published data show a net benefit in terms of IS prevention and mortality when anticoagulation is restarted. However, those studies are observational and mostly retrospective, therefore selection bias may play a major role in the results observed in these cohorts. Only randomized controlled trials, either pragmatic or explanatory, can provide more conclusive answers for this important clinical question.
BACKGROUND: We summarize the existing evidence on the potential benefit of oral anticoagulation (OAC) in intracerebral hemorrhage (ICH) survivors with nonvalvular atrial fibrillation (NVAF). METHODS: Systematic review of the literature to address the following issues: (1) prevalence of NVAF in ICH survivors, (2) current prescription of OAC, (3) factors associated with resumption of OAC, (4) risk of ischemic stroke (IS) and recurrent ICH, and (5) ideal timing for restarting OAC in ICH survivors with NVAF. RESULTS: After screening 547 articles, 26 were included in the review. Only 3 focused specifically on patients with ICH as primary event, NVAF as indication for OAC, and recurrent ICH and IS as primary endpoints. In addition, 19 letters to the editor/reviews/editorials/experts' surveys/experts' opinion were used for discussion purposes. CONCLUSIONS: NVAF is highly prevalent among ICH survivors. The risks of IS, recurrent ICH, and mortality are heightened in this group. Most published data show a net benefit in terms of IS prevention and mortality when anticoagulation is restarted. However, those studies are observational and mostly retrospective, therefore selection bias may play a major role in the results observed in these cohorts. Only randomized controlled trials, either pragmatic or explanatory, can provide more conclusive answers for this important clinical question.
Authors: Santosh B Murthy; Ajay Gupta; Alexander E Merkler; Babak B Navi; Pitchaiah Mandava; Costantino Iadecola; Kevin N Sheth; Daniel F Hanley; Wendy C Ziai; Hooman Kamel Journal: Stroke Date: 2017-04-17 Impact factor: 7.914
Authors: David R Holmes; Saibal Kar; Matthew J Price; Brian Whisenant; Horst Sievert; Shephal K Doshi; Kenneth Huber; Vivek Y Reddy Journal: J Am Coll Cardiol Date: 2014-07-08 Impact factor: 24.094
Authors: Daniel M Witt; Nathan P Clark; Kerri Martinez; Allison Schroeder; David Garcia; Mark A Crowther; Walter Ageno; Francesco Dentali; Xiangyang Ye; Elaine Hylek; Thomas Delate Journal: Thromb Res Date: 2015-10-09 Impact factor: 3.944
Authors: Marta Pasquini; Andreas Charidimou; Charlotte J J van Asch; Merih I Baharoglu; Neshika Samarasekera; David J Werring; Catharina J M Klijn; Yvo B Roos; Rustam Al-Shahi Salman; Charlotte Cordonnier Journal: Stroke Date: 2014-07-31 Impact factor: 7.914