Resuming of oral anticoagulation after intracerebral hemorrhage_West China Medical Journal

Authors：

BAI Xue ,  HU Zhi

Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

HU Zhi, Email: huzhi1111@hotmail.com

Keywords：

Intracerebral hemorrhage; Oral anticoagulant; Treatment

DOI：

10.7507/1002-0179.202003028

Video：

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Resuming oral anticoagulant (OAC) after intracerebral hemorrhage (ICH) is still a dilemma to clinical decision. To date, no high-quality randomized controlled trials demonstrate the timing and mode of safely resuming OAC. In recent years, some moderate-quality researches have suggested that OAC resuming after ICH can decrease the incidence of thromboembolic events and long-term mortality, without significantly increasing the risk of ICH; it is safer to resuming OAC in patients with non-lobar ICH than in patients with lobar-ICH; new OACs are superior to vitamin K antagonists; patients with high thromboembolic risk should resume OAC 2 weeks or even earlier after ICH, otherwise, a time-window for optimal resumption is between 4-8 weeks; meanwhile, individual patient characteristics should be considered and blood pressure should be strictly controlled.

Citation： BAI Xue, HU Zhi. Resuming of oral anticoagulation after intracerebral hemorrhage. West China Medical Journal, 2021, 36(11): 1613-1617. doi: 10.7507/1002-0179.202003028 Copy

1.	Qureshi A, Mendelow AD, Hanley DF. Intracerebral haemorrhage. Lancet, 2009, 373(9675): 1632-1644.
2.	Hemphill JC 3rd, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2015, 46(7): 2032-2060.
3.	Charidimou A, Boulouis G, Gurol ME, et al. Emerging concepts in sporadic cerebral amyloid angiopathy. Brain, 2017, 140(7): 1829-1850.
4.	Auriel E, Greenberg SM. The pathophysiology and clinical presentation of cerebral amyloid angiopathy. Curr Atheroscler Rep, 2012, 14(4): 343-350.
5.	Charidimou A, Boulouis G, Roongpiboonsopit D, et al. Cortical superficial siderosis multifocality in cerebral amyloid angiopathy: a prospective study. Neurology, 2017, 89(21): 2128-2135.
6.	Ottosen TP, Grijota M, Hansen ML, et al. Use of antithrombotic therapy and long-term clinical outcome among patients surviving intracerebral hemorrhage. Stroke, 2016, 47(7): 1837-1843.
7.	Nielsen PB, Larsen TB, Skjøth F, et al. Restarting anticoagulant treatment after intracranial hemorrhage in patients with atrial fibrillation and the impact on recurrent stroke, mortality, and bleeding: a nationwide cohort study. Circulation, 2015, 132(6): 517-525.
8.	Kuramatsu JB, Gerner ST, Schellinger PD, et al. Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. JAMA, 2015, 313(8): 824-836.
9.	Steiner T, Al-Shahi Salman R, Beer R, et al. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke, 2014, 9(7): 840-855.
10.	Bailey RD, Hart RG, Benavente O, et al. Recurrent brain hemorrhage is more frequent than ischemic stroke after intracranial hemorrhage. Neurology, 2001, 56(6): 773-777.
11.	Poli D, Antonucci E, Dentali F, et al. Recurrence of ICH after resumption of anticoagulation with VK antagonists: CHIRONE study. Neurology, 2014, 82(12): 1020-1026.
12.	Gathier CS, Algra A, Rinkel GJ, et al. Long-term outcome after anticoagulation-associated intracerebral haemorrhage with or without restarting antithrombotic therapy. Cerebrovasc Dis, 2013, 36(1): 33-37.
13.	Chao TF, Liu CJ, Liao JN, et al. Use of oral anticoagulants for stroke prevention in patients with atrial fibrillation who have a history of intracranial hemorrhage. Circulation, 2016, 133(16): 1540-1547.
14.	Park YA, Uhm JS, Pak HN, et al. Anticoagulation therapy in atrial fibrillation after intracranial hemorrhage. Heart Rhythm, 2016, 13(9): 1794-1802.
15.	Yung D, Kapral MK, Asllani E, et al. Reinitiation of anticoagulation after warfarin-associated intracranial hemorrhage and mortality risk: the best practice for reinitiating anticoagulation therapy after intracranial bleeding (BRAIN) study. Can J Cardiol, 2012, 28(1): 33-39.
16.	Biffi A, Anderson CD, Battey TW, et al. Association between blood pressure control and risk of recurrent intracerebral hemorrhage. JAMA, 2015, 314(9): 904-912.
17.	Charidimou A, Karayiannis C, Song TJ, et al. Brain microbleeds, anticoagulation, and hemorrhage risk: meta-analysis in stroke patients with AF. Neurology, 2017, 89(23): 2317-2326.
18.	Chai-Adisaksopha C, Iorio A, Hillis C, et al. Warfarin resumption following anticoagulant-associated intracranial hemorrhage: a systematic review and meta-analysis. Thromb Res, 2017, 160: 97-104.
19.	Zhou Z, Yu J, Carcel C, et al. Resuming anticoagulants after anticoagulation-associated intracranial haemorrhage: systematic review and meta-analysis. BMJ Open, 2018, 8(5): e019672.
20.	Korompoki E, Filippidis FT, Nielsen PB, et al. Long-term antithrombotic treatment in intracranial hemorrhage survivors with atrial fibrillation. Neurology, 2017, 89(7): 687-696.
21.	Murthy SB, Gupta A, Merkler AE, et al. Restarting anticoagulant therapy after intracranial hemorrhage: a systematic review and meta-analysis. Stroke, 2017, 48(6): 1594-1600.
22.	Biffi A, Kuramatsu JB, Leasure A, et al. Oral anticoagulation and functional outcome after intracerebral hemorrhage. Ann Neurol, 2017, 82(5): 755-765.
23.	Becattini C, Sembolini A, Paciaroni M. Resuming anticoagulant therapy after intracerebral bleeding. Vascul Pharmacol, 2016, 84: 15-24.
24.	Pennlert J, Overholser R, Asplund K, et al. Optimal timing of anticoagulant treatment after intracerebral hemorrhage in patients with atrial fibrillation. Stroke, 2017, 48(2): 314-320.
25.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation, 2017, 135(25): e1159-e1195.
26.	Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J, 2012, 33(19): 2451-2496.
27.	Halvorsen S, Storey RF, Rocca B, et al. Management of antithrombotic therapy after bleeding in patients with coronary artery disease and/or atrial fibrillation: expert consensus paper of the European Society of Cardiology Working Group on Thrombosis. Eur Heart J, 2017, 38(19): 1455-1462.
28.	Kuramatsu JB, Sembill JA, Gerner ST, et al. Management of therapeutic anticoagulation in patients with intracerebral haemorrhage and mechanical heart valves. Eur Heart J, 2018, 39(19): 1709-1723.
29.	Katsanos AH, Schellinger PD, Köhrmann M, et al. Fatal oral anticoagulant-related intracranial hemorrhage: a systematic review and meta-analysis. Eur J Neurol, 2018, 25(10): 1299-1302.
30.	Wolfe Z, Khan SU, Nasir F, et al. A systematic review and Bayesian network meta-analysis of risk of intracranial hemorrhage with direct oral anticoagulants. J Thromb Haemost, 2018, 16(7): 1296-1306.
31.	Chatterjee S, Sardar P, Biondi-Zoccai G, et al. New oral anticoagulants and the risk of intracranial hemorrhage: traditional and Bayesian meta-analysis and mixed treatment comparison of randomized trials of new oral anticoagulants in atrial fibrillation. JAMA Neurol, 2013, 70(12): 1486-1490.
32.	Rodrigues MA, Samarasekera N, Lerpiniere C, et al. The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: model development and diagnostic test accuracy study. Lancet Neurol, 2018, 17(3): 232-240.
33.	van Etten ES, Gurol ME, van der Grond J, et al. Recurrent hemorrhage risk and mortality in hereditary and sporadic cerebral amyloid angiopathy. Neurology, 2016, 87(14): 1482-1487.
34.	Charidimou A, Imaizumi T, Moulin S, et al. Brain hemorrhage recurrence, small vessel disease type, and cerebral microbleeds: a meta-analysis. Neurology, 2017, 89(8): 820-829.
35.	Wilson D, Ambler G, Shakeshaft C, et al. Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2): a multicentre observational cohort study. Lancet Neurol, 2018, 17(6): 539-547.
36.	Charidimou A, Boulouis G, Xiong L, et al. Cortical superficial siderosis and first-ever cerebral hemorrhage in cerebral amyloid angiopathy. Neurology, 2017, 88(17): 1607-1614.

1. Qureshi A, Mendelow AD, Hanley DF. Intracerebral haemorrhage. Lancet, 2009, 373(9675): 1632-1644.
2. Hemphill JC 3rd, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2015, 46(7): 2032-2060.
3. Charidimou A, Boulouis G, Gurol ME, et al. Emerging concepts in sporadic cerebral amyloid angiopathy. Brain, 2017, 140(7): 1829-1850.
4. Auriel E, Greenberg SM. The pathophysiology and clinical presentation of cerebral amyloid angiopathy. Curr Atheroscler Rep, 2012, 14(4): 343-350.
5. Charidimou A, Boulouis G, Roongpiboonsopit D, et al. Cortical superficial siderosis multifocality in cerebral amyloid angiopathy: a prospective study. Neurology, 2017, 89(21): 2128-2135.
6. Ottosen TP, Grijota M, Hansen ML, et al. Use of antithrombotic therapy and long-term clinical outcome among patients surviving intracerebral hemorrhage. Stroke, 2016, 47(7): 1837-1843.
7. Nielsen PB, Larsen TB, Skjøth F, et al. Restarting anticoagulant treatment after intracranial hemorrhage in patients with atrial fibrillation and the impact on recurrent stroke, mortality, and bleeding: a nationwide cohort study. Circulation, 2015, 132(6): 517-525.
8. Kuramatsu JB, Gerner ST, Schellinger PD, et al. Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. JAMA, 2015, 313(8): 824-836.
9. Steiner T, Al-Shahi Salman R, Beer R, et al. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke, 2014, 9(7): 840-855.
10. Bailey RD, Hart RG, Benavente O, et al. Recurrent brain hemorrhage is more frequent than ischemic stroke after intracranial hemorrhage. Neurology, 2001, 56(6): 773-777.
11. Poli D, Antonucci E, Dentali F, et al. Recurrence of ICH after resumption of anticoagulation with VK antagonists: CHIRONE study. Neurology, 2014, 82(12): 1020-1026.
12. Gathier CS, Algra A, Rinkel GJ, et al. Long-term outcome after anticoagulation-associated intracerebral haemorrhage with or without restarting antithrombotic therapy. Cerebrovasc Dis, 2013, 36(1): 33-37.
13. Chao TF, Liu CJ, Liao JN, et al. Use of oral anticoagulants for stroke prevention in patients with atrial fibrillation who have a history of intracranial hemorrhage. Circulation, 2016, 133(16): 1540-1547.
14. Park YA, Uhm JS, Pak HN, et al. Anticoagulation therapy in atrial fibrillation after intracranial hemorrhage. Heart Rhythm, 2016, 13(9): 1794-1802.
15. Yung D, Kapral MK, Asllani E, et al. Reinitiation of anticoagulation after warfarin-associated intracranial hemorrhage and mortality risk: the best practice for reinitiating anticoagulation therapy after intracranial bleeding (BRAIN) study. Can J Cardiol, 2012, 28(1): 33-39.
16. Biffi A, Anderson CD, Battey TW, et al. Association between blood pressure control and risk of recurrent intracerebral hemorrhage. JAMA, 2015, 314(9): 904-912.
17. Charidimou A, Karayiannis C, Song TJ, et al. Brain microbleeds, anticoagulation, and hemorrhage risk: meta-analysis in stroke patients with AF. Neurology, 2017, 89(23): 2317-2326.
18. Chai-Adisaksopha C, Iorio A, Hillis C, et al. Warfarin resumption following anticoagulant-associated intracranial hemorrhage: a systematic review and meta-analysis. Thromb Res, 2017, 160: 97-104.
19. Zhou Z, Yu J, Carcel C, et al. Resuming anticoagulants after anticoagulation-associated intracranial haemorrhage: systematic review and meta-analysis. BMJ Open, 2018, 8(5): e019672.
20. Korompoki E, Filippidis FT, Nielsen PB, et al. Long-term antithrombotic treatment in intracranial hemorrhage survivors with atrial fibrillation. Neurology, 2017, 89(7): 687-696.
21. Murthy SB, Gupta A, Merkler AE, et al. Restarting anticoagulant therapy after intracranial hemorrhage: a systematic review and meta-analysis. Stroke, 2017, 48(6): 1594-1600.
22. Biffi A, Kuramatsu JB, Leasure A, et al. Oral anticoagulation and functional outcome after intracerebral hemorrhage. Ann Neurol, 2017, 82(5): 755-765.
23. Becattini C, Sembolini A, Paciaroni M. Resuming anticoagulant therapy after intracerebral bleeding. Vascul Pharmacol, 2016, 84: 15-24.
24. Pennlert J, Overholser R, Asplund K, et al. Optimal timing of anticoagulant treatment after intracerebral hemorrhage in patients with atrial fibrillation. Stroke, 2017, 48(2): 314-320.
25. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation, 2017, 135(25): e1159-e1195.
26. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J, 2012, 33(19): 2451-2496.
27. Halvorsen S, Storey RF, Rocca B, et al. Management of antithrombotic therapy after bleeding in patients with coronary artery disease and/or atrial fibrillation: expert consensus paper of the European Society of Cardiology Working Group on Thrombosis. Eur Heart J, 2017, 38(19): 1455-1462.
28. Kuramatsu JB, Sembill JA, Gerner ST, et al. Management of therapeutic anticoagulation in patients with intracerebral haemorrhage and mechanical heart valves. Eur Heart J, 2018, 39(19): 1709-1723.
29. Katsanos AH, Schellinger PD, Köhrmann M, et al. Fatal oral anticoagulant-related intracranial hemorrhage: a systematic review and meta-analysis. Eur J Neurol, 2018, 25(10): 1299-1302.
30. Wolfe Z, Khan SU, Nasir F, et al. A systematic review and Bayesian network meta-analysis of risk of intracranial hemorrhage with direct oral anticoagulants. J Thromb Haemost, 2018, 16(7): 1296-1306.
31. Chatterjee S, Sardar P, Biondi-Zoccai G, et al. New oral anticoagulants and the risk of intracranial hemorrhage: traditional and Bayesian meta-analysis and mixed treatment comparison of randomized trials of new oral anticoagulants in atrial fibrillation. JAMA Neurol, 2013, 70(12): 1486-1490.
32. Rodrigues MA, Samarasekera N, Lerpiniere C, et al. The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: model development and diagnostic test accuracy study. Lancet Neurol, 2018, 17(3): 232-240.
33. van Etten ES, Gurol ME, van der Grond J, et al. Recurrent hemorrhage risk and mortality in hereditary and sporadic cerebral amyloid angiopathy. Neurology, 2016, 87(14): 1482-1487.
34. Charidimou A, Imaizumi T, Moulin S, et al. Brain hemorrhage recurrence, small vessel disease type, and cerebral microbleeds: a meta-analysis. Neurology, 2017, 89(8): 820-829.
35. Wilson D, Ambler G, Shakeshaft C, et al. Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2): a multicentre observational cohort study. Lancet Neurol, 2018, 17(6): 539-547.
36. Charidimou A, Boulouis G, Xiong L, et al. Cortical superficial siderosis and first-ever cerebral hemorrhage in cerebral amyloid angiopathy. Neurology, 2017, 88(17): 1607-1614.

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