Anticoagulation for atrial fibrillation after intracranial hemorrhage: A systematic review

Maximiliano A. Hawkes, Alejandro Rabinstein

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)48-57
Number of pages10
JournalNeurology: Clinical Practice
Volume8
Issue number1
DOIs
StatePublished - Feb 1 2018

Fingerprint

Intracranial Hemorrhages
Cerebral Hemorrhage
Atrial Fibrillation
Survivors
Stroke
Mortality
Selection Bias
Expert Testimony
Observational Studies
Prescriptions
Randomized Controlled Trials

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Anticoagulation for atrial fibrillation after intracranial hemorrhage : A systematic review. / Hawkes, Maximiliano A.; Rabinstein, Alejandro.

In: Neurology: Clinical Practice, Vol. 8, No. 1, 01.02.2018, p. 48-57.

Research output: Contribution to journalReview article

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